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Published on: June 2, 2014
How general practitioners treat migraine in children--evaluation of a headache guideline
Ilse F de Coo1, Gosse de Jong, Ronald Zielman
1Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
Insights
General practitioners frequently prescribed migraine medications not recommended for children under 18. This study investigated which factors influenced these prescribing choices in Dutch pediatric migraine patients.
Area of Science:
- Pediatric Neurology
- Pharmacology
- General Practice
Background:
- Migraine significantly impacts children's quality of life.
- General practitioners (GPs) in the Netherlands manage most pediatric migraine cases.
- Current guidelines recommend rest and acetaminophen for pediatric migraine.
Purpose of the Study:
- To assess GP prescribing patterns for pediatric migraine.
- To determine if GPs deviate from Dutch College of General Practitioners guidelines.
- To identify clinical factors associated with non-guideline medication use.
Main Methods:
- Retrospective cross-sectional study of pediatric migraine patients (<18 years).
- Analysis of hospital records and questionnaires.
- Investigation of prescribed medications and patient characteristics.
Main Results:
- 41.3% of referred pediatric migraine patients received non-guideline medications.
- In younger children (<12 years), non-guideline use correlated with older age.
- In older children (>11 years), non-guideline use linked to longer migraine history and attack duration.
Conclusions:
- A significant proportion of pediatric migraine patients referred to secondary care received medications outside of GP guidelines.
- Prescribing practices varied based on patient age and migraine history.
Background:
Migraine is a common illness in children associated with a negative impact on the quality of life. In the Netherlands, treatment of migraine is commonly performed by general practitioners (GPs). The migraine guideline of the Dutch College of General Practitioners recommends inactivity and acetaminophen in patients with migraine who are younger than 18 years of age.
Objective:
The aim of our study was to evaluate the pharmacological treatment of migraine in children by GPs before referral to the hospital. Our objective was to answer the following questions. First, are GPs inclined to prescribe medication not listed in the Dutch College of General Practitioners Guideline? Second, which clinical characteristics are associated with the use of medication not listed in this guideline?
Methods:
In this retrospective cross-sectional study, prescribed medication and migraine characteristics were investigated in Dutch migraine patients (age <18 years), using hospital records and a paper-and-pencil questionnaire.
Results:
A total of 223 children were included. Medications not listed in the guideline were used in 41.3% of the patients before referral. In children younger than 12 years, the use of medication not listed in the guideline was associated with an older age, when compared with children who were treated according to the guideline. In the group of patients older than 11 years, the use of medication not listed in the guideline was associated with a longer history of migraine and a longer duration of the migraine attacks.
Conclusions:
Medications not listed in the GPs guideline were used in a large portion of the patients younger than 18 years with migraine who were referred to secondary care.
