What happens to new-onset headache in children that present to primary care? A case-cohort study using electronic
D Kernick1, S Stapley, J Campbell
1Primary Care Research Group, Peninsula College of Medicine and Dentistry, St Luke's Campus, University of Bristol, Bristol, UK. su1838@eclipse.co.uk
Insights
Primary care physicians may underdiagnose migraine in children. Early diagnosis of primary headache disorders in children reduces the risk of serious secondary pathologies.
Area of Science:
- Pediatric Neurology
- Primary Care Medicine
- Epidemiology
Background:
- Headache is a common presenting complaint in children attending primary care.
- Accurate diagnosis and management are crucial to rule out serious secondary causes and ensure appropriate treatment.
Purpose of the Study:
- To analyze the diagnostic patterns, treatment, and clinical outcomes of children presenting with headache in UK primary care.
- To assess the association between headache presentation and subsequent serious pathologies.
Main Methods:
- A historical cohort study utilized data from the UK General Practitioner Research Database.
- Children aged 5-17 with primary or undifferentiated headache were compared to age, sex, and practice-matched controls.
- Consultations, referrals, treatments, and diagnoses in the subsequent year were examined.
Main Results:
- Over 48,000 children with headache were identified; most (79.7%) initially received no formal diagnosis.
- Migraine was diagnosed in 19.2% at presentation, with a further 5.4% diagnosed in the following year.
- Headache presentation was a risk factor for serious pathologies, but this risk decreased with a primary headache diagnosis.
Conclusions:
- General practitioners may be underdiagnosing primary headache disorders, particularly migraine, in children.
- Prompt diagnosis of primary headache disorders in children is vital for mitigating risks associated with potential secondary pathologies.
- Findings can inform primary care management guidelines for pediatric headache presentations.
Abstract:
The aim was to describe the consulting behaviour and clinical outcomes of children presenting with headache in primary care. This was a historical cohort study using data from the UK General Practitioner Research Database. Cases were children aged 5-17 years who presented to primary care with primary headache (migraine, tension-type headache, cluster headache) or undifferentiated headache (no further descriptor). Controls were age, sex and practice matched. Their records were examined for consultations, referrals, relevant treatments and specific diseases in the subsequent year. Children with headache (n = 48 575) were identified and matched to controls. At presentation, 9321 (19.2%) of headaches were labelled primary, 549 (1.1%) secondary and 38 705 (79.7%) received no formal diagnosis. Of the latter group, 2084 (5.4%) received a primary headache diagnosis in the subsequent year. Following a diagnosis of migraine, 258 (3.5%) had received a triptan and 1598 (21%) were using propranolol or pizotifen. Total consultations were higher in cases than in controls in the year before the headache: cases ages 5-8 years, mean (s.d.) 5.0 (4.0) consultations; controls 4.0 (3.5) consultations. In 1 year controls had 43 430 consultations, of which 256 (0.6%) were for headache, of whom 64 (25%) were referred to secondary care. Headache was a risk factor for benign and malignant tumours, cerebrovascular disease, primary disorders of raised intracranial pressure and depression. This risk was reduced if a diagnosis of a primary headache disorder could be made. Although there is an increased likelihood of a serious pathology with headache presentations, the risk is small particularly if a diagnosis of a primary headache is made. General practitioners are likely to be underdiagnosing migraine. This study can inform management guidelines for new presentations of headache in primary care, particularly when a secondary pathology is suspected.
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