Your Child’s Migraines: Navigating the ER

Migraines are among the most common reasons for children to visit an emergency room for medical care. After all, there are about 7 million children in the United States who live with migraines. Knowing when to take your child to the ER and how to manage the wait there is important for a speedy recovery and in preventing future migraines.

Your Child’s Migraine Action Plan

A migraine is not just a bad headache. It’s a disabling neurological disease with different symptoms and treatment approaches from other headache disorders, and it has no cure.

Because of this, every child who suffers from migraines should have a written pediatric migraine action plan, which helps you and your child manage the disease more effectively at home, in school and during after-school activities. It is composed of three parts: prevention, treatment when the migraine starts, and what to do if treatment isn’t working or if a new or concerning symptom arises. The plan should be specific to your child’s needs and include:

• Diagnosis
• Factors that trigger migraines
• Medication options
• Treatments that usually are successful
• Contact information for parents and doctor

A pediatric migraine action plan is filled out mostly by your child’s healthcare team. However, the prevention section is completed by the parents, the child and the provider so they can set some healthy lifestyle goals. But all the adults in the child’s life — parents, doctors, teachers, coaches and school nurses — are responsible for sticking to the plan. Headache: The Journal of Head and Face Pain offers a customizable migraine action plan that you can download to get started.

When Should My Child Go to the ER?

If you have worked through your child’s migraine action plan and nothing is providing relief, it may be time to head to the ER. Remember that if your child’s migraines can be treated effectively when they first start, they are less likely to occur as frequently in the future.

In addition to the unrelenting pain, signs that you should take your child to the ER include:

• Any new symptom
• A level of pain that is new to your child
• Auras (vision loss, flashing lights) if your child has never had them
• Weakness
• Speech problems
• Dizziness
• Neck stiffness
• Fever

What Can ER Do?

ER doctors are not specialists in migraines. Their goals are to make sure your child doesn’t have a life-threatening problem and to help reduce your child’s suffering. Once any serious conditions are ruled out, your child is likely to have an IV put in to quickly receive the medication the doctor prescribes. That combination usually contains:

• Fluids (Dehydration is a common trigger for migraines and can get worse when your child is suffering from a migraine.)
• Pain medication that is stronger than what your child takes at home
• Nausea medication

In addition, the IV fluids and medication will help your child sleep, which is one of the best ways for the body to fight off a migraine.

How To Make Waiting Easier

Unfortunately, waiting to be seen by a doctor in the ER can be unbearable if your child is experiencing a migraine. That’s because migraines often are accompanied by nausea, vomiting and extreme sensitivity to light and sound, and waiting rooms typically are noisy, busy places.

To make the experience easier on your child, try these tips:

• Have your child wear sunglasses and headphones
• Place a cold cloth or ice on the neck
• Give your child small sips of water
• Ask if there is a quiet place to wait
• Wait in your car

Because migraines are invisible, it is important for parents to advocate for their children by explaining what they need each step of the way.