Diagnostic testing and treatment of pediatric headache in the emergency department
David C Sheridan1, Garth D Meckler, David M Spiro
1Department of Pediatrics, Oregon Health and Science University, Portland, OR.
Insights
Pediatric headache care in emergency departments (EDs) varies widely. Many children with migraine receive non-evidence-based treatments like opioids and CT scans, despite clinical guidelines.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Health Services Research
Background:
- Headaches are a common reason for pediatric emergency department visits.
- Variability exists in diagnostic approaches and treatment strategies for pediatric headaches.
Purpose of the Study:
- To describe the variability in diagnostic testing and treatment of headaches in children presenting to the emergency department (ED).
- To assess the use of evidence-based treatment for pediatric headache and migraine in the ED.
Main Methods:
- Retrospective cohort study using the National Hospital Ambulatory Medical Care Survey (2005-2009).
- Analysis of pediatric patients (<18 years) with a primary discharge diagnosis of headache or migraine.
Main Results:
- 1.7 million ED visits nationally for headache; 340,000 for migraine.
- Neuroimaging (37%) and blood tests (39%) common for headache; opioids and NSAIDs frequent treatments.
- 40% of migraine patients received non-evidence-based treatment, including opioids; >20% had CT scans.
Conclusions:
- Significant variability in pediatric headache evaluation and treatment in the ED.
- Many children with migraine receive treatments contrary to evidence-based guidelines, including opioids and ionizing radiation.
Objective:
To describe the variability in diagnostic testing and treatment of headaches in children presenting to the emergency department (ED) with use of a nationally representative sample.
Study Design:
This was a retrospective cohort study using the National Hospital Ambulatory Medical Care Survey during 2005-2009. To assess the use of evidence-based treatment, we analyzed all patients <18 years old in 2 groups: (1) primary discharge diagnosis of headache and (2) discharge diagnosis of migraine.
Results:
Four hundred forty-eight sampled ED visits from 2005-2009 represented a national estimate of 1.7 million visits with a discharge diagnosis of headache. A total of 95 visits represented a national estimate of 340 000 visits with a discharge diagnosis of migraine. Median age was 13.1 years and 60% were female with a primary diagnosis of headache. In this group, neuroimaging was performed in 37% of patients and 39% underwent blood tests. Nonsteroidal anti-inflammatory drugs and opioids were most commonly used for treatment. For children with a discharge diagnosis of migraine, approximately 40% of patients received non-evidence-based treatment, most commonly with opioid medications, and >20% of patients underwent computed tomography scanning.
Conclusions:
There is significant variability in the evaluation and treatment of pediatric headache in the ED. Despite evidence-based clinical guidelines for migraine headache, a large number of children continue to receive opioids and ionizing radiation in the ED.
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