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Published on: June 2, 2014
Disparities and Trends in Migraine Management in Pediatric Emergency Departments, 2009-19
Katia C Genadry1, Michael C Monuteaux1, Mark I Neuman1
1Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School (KC Genadry, MC Monuteaux, MI Neuman, and LK Lee), Boston, Mass.
Insights
Migraine management in children evolved, with decreased opioid use and increased nonopioid medications. Clinical guidelines reduced opioid prescriptions, suggesting standardization can improve care equity.
Area of Science:
- Pediatric Neurology
- Health Services Research
- Clinical Pharmacology
Background:
- Migraine is a common neurological disorder in children and adolescents.
- Management of pediatric migraine varies significantly across healthcare settings.
- Understanding trends and disparities in migraine treatment is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze changes in migraine management strategies over time in US children's hospitals.
- To identify factors contributing to variations and disparities in pediatric migraine care.
- To evaluate the impact of clinical guidelines on treatment patterns.
Main Methods:
- Retrospective analysis of 112,077 pediatric migraine visits (2009-2019) from the Pediatric Health Information System.
- Survey of 32 hospitals regarding the presence of clinical guidelines for migraine management.
- Multivariable logistic regression to assess medication and advanced imaging use based on patient demographics and guideline presence.
Main Results:
- Opioid use for pediatric migraine decreased, while nonopioid analgesics, dopamine antagonists, and diphenhydramine use increased.
- Older adolescents (14-21 years) had higher odds of opioid use; clinical guidelines were associated with decreased opioid use.
- Hispanic ethnicity was linked to increased head CT use, while older age and female sex were associated with decreased head CT use.
Conclusions:
- Pediatric migraine treatment has shifted towards nonopioid medications, with variations influenced by patient demographics and hospital guidelines.
- Hospitals with clinical guidelines demonstrated reduced opioid prescribing for pediatric migraine.
- Standardizing migraine management protocols may help mitigate disparities and improve consistency in care for pediatric patients.
Objective:
To assess the variation in migraine management over time across US children's hospitals and to identify factors associated with disparities in management.
Methods:
We conducted a retrospective study of 32 hospitals in the Pediatric Health Information System from 2009 to 2019. We included children 7 to 21 years old with primary ICD-9 or ICD-10 diagnosis codes for migraine headache. We surveyed hospitals to assess for clinical guideline presence. We assessed medication use trends over time. To examine differences in medication and advanced head imaging use by patient characteristics and presence of clinical guideline, we performed multivariable logistic regression analyses reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI).
Results:
We identified 112,077 eligible visits. Opioid use decreased over time, while nonopioid analgesic, dopamine antagonist, and diphenhydramine use increased. Multivariable analysis for opioids revealed increased odds of use for those 14 to 17 (aOR 1.19; 95% CI, 1.06, 1.34) and 18 to 21 years old (aOR 1.69; CI, 1.37, 2.08), and clinical guideline presence had decreased odds (aOR 0.64; CI, 0.48, 0.84). For head computed tomography, increased odds of use were reported for Hispanic ethnicity (aOR 1.15; CI, 1.06, 1.24) and decreased odds for 14 to 17 years (aOR 0.85; CI, 0.80, 0.90), 18 to 21 years (aOR 0.87; CI, 0.77, 0.98), and female sex (aOR 0.74; CI, 0.70, 0.79).
Conclusions:
Opioid use decreased while other medications increased over time. Medication and imaging differed by demographic characteristics. Opioid use was less likely in hospitals with clinical guidelines. Standardization in management may decrease care disparities and variability.
