What is the recommended treatment for a pediatric patient with migraine headache that has not responded to ibuprofen?

Rizatriptan 5 mg orally is the recommended treatment for a pediatric patient with a migraine headache who has not responded to ibuprofen. Triptans, such as rizatriptan, are specifically designed to treat migraines by acting as agonists at serotonin receptors, which helps to alleviate headache symptoms by promoting vasoconstriction and inhibiting the release of pro-inflammatory mediators. In cases where initial treatments like ibuprofen are ineffective, rizatriptan offers an alternative that is more targeted towards resolving the underlying migraine pathophysiology.

In contrast, acetaminophen is typically less effective for migraines compared to triptans, and although it can be used for mild headache relief, it doesn't provide the same level of action on the migraine mechanism. Increasing the ibuprofen dosage would not be appropriate since the patient has already shown a lack of response at a lower dose; thus, it does not address the inadequacy of the initial treatment. Lastly, administering 0.9% sodium chloride intravenously would not be a treatment for migraine and is irrelevant in this context, as hydration alone does not resolve a migraine attack and does not exert the therapeutic effects required for migraine relief.

Therefore, the rationale for selecting rizatriptan is based