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Published on: June 2, 2014
Treatment of children with migraine in emergency departments: national practice variation study
Lawrence P Richer1, Keri Laycock, Kelly Millar
1University of Alberta, Department of Pediatrics, Edmonton, Alberta, Canada. lricher@ualberta.ca
Insights
Pediatric migraine patients in emergency departments often have frequent attacks and have tried many treatments. Significant variations in migraine-abortive medication use were observed among Canadian pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Pharmacology
Background:
- Children with migraine frequently present to emergency departments (EDs) after outpatient management fails.
- Research on migraine-abortive medications specifically for pediatric populations in ED settings is limited.
Purpose of the Study:
- To examine the use of migraine-abortive medications in children presenting to Canadian pediatric EDs.
- To identify variations in treatment practices and predictors of evidence-based care.
Main Methods:
- Retrospective chart review of pediatric ED visits for migraine/headache over one year (2004-2005).
- Inclusion criteria focused on ED presentations for migraine or headache.
- Evidence-based treatments were defined as those with high-quality evidence and no opioids as first-line agents.
Main Results:
- 1694 children met inclusion criteria; average age was 12.1 years.
- 62.6% had prior migraine-abortive therapy use; 14.5% experienced headaches >15 days/month.
- Dopamine receptor antagonists (39%) and analgesics (24.5%) were most common; significant practice variations noted.
- Older age and a migraine diagnosis predicted evidence-based treatment.
Conclusions:
- Children with frequent migraine attacks often present to EDs after failed outpatient treatments.
- Significant practice variations exist in the administration of migraine-abortive medications for pediatric patients in Canadian EDs.
Objective:
Children with migraine may present to an emergency department (ED) when outpatient management has failed; however, only limited research has examined migraine-abortive medications among children.
Methods:
A retrospective chart review of ED presentations for migraine or headache between July 1, 2004, and June 30, 2005, in 10 Canadian pediatric EDs was conducted. A priori, evidence-based treatments were defined as any treatment that was based on high-quality evidence and an absence of opioids as first-line agents.
Results:
A total of 2515 records were screened, and 1694 (67.4%) met inclusion criteria. The average age of patients was 12.1 years, 14.5% (95% confidence interval [CI]: 12.1%-17.2%) of patients experienced headache >15 days per month, and 62.6% (95% CI: 55.7%-68.9%) had already used migraine-abortive therapy. Significant variations in practice for all classes of migraine-abortive medications were observed. Dopamine receptor antagonists (prochlorperazine, metoclopramide, or chlorpromazine) (39% [95% CI: 28.4%-50.8%]) and orally administered analgesics (acetaminophen and ibuprofen) (24.5% [95% CI: 23.9%-46.8%]) were prescribed most commonly. Predictors for the use of evidence-based treatment included older age (odds ratio: 1.15 [95% CI: 1.07-1.24]) and a discharge diagnosis of migraine (odds ratio: 1.84 [95% CI: 1.11-3.05]).
Conclusions:
Children presenting to EDs for treatment often have frequent attacks and have experienced failure of outpatient, migraine-abortive efforts. Practice variations were impressive for the care of children with migraine in these Canadian EDs.