Increase the proportion of children with migraine presenting to the emergency department (ED) who are pain-free within 2 hours of initial medication administration (primary outcome measure).

Implementation of a pediatric acute migraine protocol in the ED improves compliance with evidence-based practices. Use of evidence-based therapies for pediatric migraine results in better rates of pain relief and fewer adverse side effects as compared to other migraine therapies.

Model for Improvement methodology, a multi-disciplinary team, and iterative plan-do-study-act cycles were used to increase the provision of evidence-based care to children with migraine. Secondary measures included ED length-of-stay (outcome measure) and 72-hour ED re-visit rates (balancing measure). Baseline data were collected for six months, and measures were tracked monthly using statistical process control charts. Key interventions included (1) dissemination of our care pathway using emails to providers, the housestaff manual, and postings in the provider work-area, (2) pathway-specific electronic medical record (EMR) order sets, and (3) didactic education sessions.

The proportion of children pain-free within 2 hours increased from a baseline of 19% to 50% (12 out of 13 points above centerline) with implementation of our migraine pathway. No special cause variation was observed in ED length-of-stay or rates of 72 hour ED re-visits for migraine headache.

Implementation of a protocol and pathway-specific EMR order sets improved pain-free rates in children with acute migraine in the ED. Standardized, evidence-based medication delivery is key in improving the acute care of children with migraine headache.