Abstract
Objective
To assess the variation in migraine management over time across US children's hospitals
and to identify factors associated with disparities in management.
Methods
We conducted a retrospective study of 32 hospitals in the Pediatric Health Information
System from 2009 to 2019. We included children 7 to 21 years old with primary ICD-9
or ICD-10 diagnosis codes for migraine headache. We surveyed hospitals to assess for
clinical guideline presence. We assessed medication use trends over time. To examine
differences in medication and advanced head imaging use by patient characteristics
and presence of clinical guideline, we performed multivariable logistic regression
analyses reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI).
Results
We identified 112,077 eligible visits. Opioid use decreased over time, while nonopioid
analgesic, dopamine antagonist, and diphenhydramine use increased. Multivariable analysis
for opioids revealed increased odds of use for those 14 to 17 (aOR 1.19; 95% CI, 1.06,
1.34) and 18 to 21 years old (aOR 1.69; CI, 1.37, 2.08), and clinical guideline presence
had decreased odds (aOR 0.64; CI, 0.48, 0.84). For head computed tomography, increased
odds of use were reported for Hispanic ethnicity (aOR 1.15; CI, 1.06, 1.24) and decreased
odds for 14 to 17 years (aOR 0.85; CI, 0.80, 0.90), 18 to 21 years (aOR 0.87; CI,
0.77, 0.98), and female sex (aOR 0.74; CI, 0.70, 0.79).
Conclusions
Opioid use decreased while other medications increased over time. Medication and imaging
differed by demographic characteristics. Opioid use was less likely in hospitals with
clinical guidelines. Standardization in management may decrease care disparities and
variability.
Keywords
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References
- Pediatric migraine.Neurol Clin. 2009; 27: 481-501
- Quality of life in paediatric migraine: characterization of age-related effects using PedsQL 4.0.Cephalalgia. 2004; 24: 120-127
- Quality of life and health-related disability in children with migraine.Headache. 2014; 54: 325-334
- A comparison of acute treatment regimens for migraine in the emergency department.Pediatrics. 2015; 135: 232-238
- Practice guideline update summary: acute treatment of migraine in children and adolescents: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society [published correction appears in Neurology. 2020 Jan 7;94:50].Neurology. 2019; 93: 487-499https://doi.org/10.1212/WNL.0000000000008095
- Chlorpromazine for the treatment of migraine in a pediatric emergency department.Headache. 2014; 54: 335-342
- Emergency department management of acute migraine in children in Canada: a practice variation study.Headache. 2007; 47: 703-710
- Treatment of children with migraine in the emergency department: a qualitative systematic review.Pediatr Emerg Care. 2008; 24: 321-330
- The use of a pediatric migraine practice guideline in an emergency department setting.Pediatr Emerg Care. 2016; 32: 435-439
- Effectiveness of standardized combination therapy for migraine treatment in the pediatric emergency department.Headache. 2013; 53: 491-497
- Comprehensive migraine initiative in the pediatric emergency department improves treatment outcomes.J Child Neurol. 2020; 35: 235-241
- Emergency department use of neuroimaging in children and adolescents presenting with headache.J Pediatr. 2018; 201: 196-201
- The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: statistics from National Survey studies.Headache. 2015; 55: 214-228
- Minority representation in migraine treatment trials.Headache. 2017; 57: 525-533
- A critical exploration of migraine as a health disparity: the imperative of an equity-oriented, intersectional approach.Curr Pain Headache Rep. 2018; 22: 79
- Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.BMC Pediatr. 2014; 14: 199
Association CsH. Available at: https://www.childrenshospitals.org/Programs-and-Services/Data-Analytics-and-Research/Pediatric-Analytic-Solutions. Accessed September 1, 2020.
- Acute headache management in emergency department. A narrative review.Intern Emerg Med. 2020; 15: 109-117
- The American Academy of Neurology's top five choosing wisely recommendations.Neurology. 2013; 81: 1004-1011
- Management of adults with acute migraine in the emergency department: the American Headache Society evidence assessment of parenteral pharmacotherapies.Headache. 2016; 56: 911-940
- Management of pediatric migraine in a tertiary care versus community based emergency department: an observational pilot study.Pediatr Neurol. 2014; 50: 164-170
- Diagnosis of migraine in the pediatric emergency department.Pediatr Neurol. 2013; 49: 40-45
- Disability in strategies of care study g. Stratified care vs step care strategies for migraine: the Disability in strategies of Care (DISC) study: a randomized trial.JAMA. 2000; 284: 2599-2605
- Migraine: integrated approaches to clinical management and emerging treatments.Lancet. 2021; 397: 1505-1518
- Medication-overuse headache and opioid-induced hyperalgesia: a review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment.Cephalalgia. 2013; 33: 52-64
- Impact of emergency department opioid use on future health resource utilization among patients with migraine.Headache. 2021; 61: 287-299
- Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.Neurology. 2000; 55: 754-762
- Prophylactic administration of diphenhydramine to reduce neuroleptic side effects in the acute care setting: a systematic review and meta analysis.J Emerg Med. 2021; 60: 165-174https://doi.org/10.1016/j.jemermed.2020.09.031
- Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions.J Asthma. 2015; 52: 806-814
- A QI initiative to reduce hospitalization for children with isolated skull fractures.Pediatrics. 2016; 137: e20153370
- Early involvement of the child protection team in the care of injured infants in a pediatric emergency department.J Emerg Med. 2019; 56: 592-600
- Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline.J Pediatr Surg. 2009; 44 (discussion 1234-1225): 1229-1234
- Cranial computed tomography use among children with minor blunt head trauma: association with race/ethnicity.Arch Pediatr Adolesc Med. 2012; 166: 732-737
- Trends in use of advanced imaging in pediatric emergency departments, 2009-2018.JAMA Pediatr. 2020; 174e202209
- Quality improvement effort to reduce cranial CTs for children with minor blunt head trauma.Pediatrics. 2015; 136: e227-e233
Article Info
Publication History
Published online: May 21, 2022
Accepted:
April 15,
2022
Received:
November 25,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
