Brain imaging and prophylactic therapy in children with migraine: recommendations versus reality

To determine the concordance between referring physician behavior and published criteria for performance of imaging studies and institution of prophylactic therapy, respectively, in children referred to an academic children's hospital headache clinic. Study design A retrospective review of the records of 106 consecutive patients referred to an academic children's hospital headache clinic.

Approximately half of patients referred to the clinic had already had head computed tomography or magnetic resonance imaging ordered by the referring doctor and performed before their clinic appointment. However, using published criteria, only 10% of patients seen in the clinic would have required an imaging procedure before institution of therapy. The referring physician had initiated treatment with daily prophylactic medications for headache in more than 30% of patients before their clinic appointments, of whom 89% were on appropriate medications at age-appropriate and weight-appropriate doses. Half of these children exhibited a positive response to this medication before being seen by the consulting neurologist. However, more than 60% of the children actually met the criteria for recommending prophylactic therapy.

Imaging is more frequently obtained and prophylactic therapy less frequently implemented by the referring physician than would be indicated by published recommendations.