Headache Type
|
Treatment
|
Comment
|
Migraine
|
Ibuprofen, 10 milligrams/kg PO, or acetaminophen, 15 milligrams/kg PO/PR
|
Ibuprofen superior to acetaminophen in one trial
|
Sumatriptan, 10 milligrams via nasal spray (20–39 kg) or 20 milligrams via nasal spray (>40 kg), or 0.06 milligram/kg SC
|
Nasal or injectable preferred; no difference between oral sumatriptan and placebo
|
Rizatriptan, 5 milligrams PO
|
Efficacy not statistically significant over placebo
|
Dihydroergotamine, 0.1 milligram/kg (ages 6–9), 0.15 milligram/kg (ages 9–12), 0.2 milligram/kg (ages 12–16)
|
Contraindicated in complex migraine
|
Prochlorperazine, 0.15 milligram/kg IV
|
Consider diphenhydramine 1 milligram/kg to prevent or treat dystonic reactions
|
Cluster
|
100% oxygen at 7 L/min via non-rebreather mask at onset of headache
|
Most useful at onset of symptoms, less effective later in course of headache
|
Ergotamine, 0.1 milligram/dose (ages 6–9), 0.5 milligram/dose (ages 9–12), 0.75 milligram/dose (ages 12–16)
|
—
|
Sumatriptan
|
Nasal spray or IM dosing as for migraine
|
Lidocaine, 1% solution in ipsilateral nostril
|
Effective for mild to moderate pain, can instill via atomizer and syringe
|
Prednisone, 1–2 milligrams/kg for 10 d with subsequent 7-d taper
|
Effective at terminating prolonged cluster headaches and preventing recurrence
|
Tension
|
Ibuprofen, 10 milligrams/kg PO, or acetaminophen, 15 milligrams/kg PO/PR
|
—
|