Child Headache & Vomiting After Maxalt: Urgent Evaluation Needed

A 5-year-old with headache and vomiting after rizatriptan (Maxalt) requires immediate medical assessment. Maxalt is **not FDA-approved for children <6 years** (approved ≥6 for acute migraine).

Possible Explanations

• Migraine: Can occur in young children; vomiting is common. But diagnosis requires exclusion of other causes.
• Medication adverse effect: Rizatriptan side effects: nausea, vomiting, dizziness, paresthesia, chest tightness. Higher risk on empty stomach or in drug-naïve child.
• Secondary headache: Infection (sinusitis, meningitis), increased ICP (hydrocephalus, mass), trauma, metabolic.
• Cyclic vomiting syndrome: Episodic severe vomiting; migraine variant.

Red Flags (Emergency)

• Altered mental status, lethargy, irritability.
• Fever, neck stiffness, photophobia.
• Focal neurological signs.
• Signs of dehydration (dry mucous membranes, decreased urine, sunken eyes).
• Headache awakens from sleep, worsens with Valsalva.

Immediate Steps

1. Stop Maxalt. Do not give another dose.
2. Seek care now: ER or urgent pediatric neurology.
3. Hydration: Oral rehydration if alert; IV if dehydrated.
4. Do not give OTC meds without medical direction.

Follow-Up

• Pediatric neurologist for headache workup (history, exam, possibly MRI).
• Headache diary: triggers, patterns, response.
• Age-appropriate acute/preventive plan (ibuprofen, triptans if ≥6, lifestyle).

Never give adult migraine medication to a young child without pediatric specialist prescription. Safety first.