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Published on: June 2, 2014
Evolution of Pediatric Migraine Patients Admitted at an Emergency Department after a 10-Year Follow-Up
Maria Laura Manzo1, Federica Reina1, Edvige Correnti2
1Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro", University of Palermo, 90100 Palermo, Italy.
Insights
This 10-year follow-up study found that pediatric migraine patients initially seen in the emergency department generally have a favorable long-term prognosis. However, familial neurological comorbidity and sleep disorders were identified as predictors of persistent migraine headaches.
Area of Science:
- Neurology
- Pediatrics
- Clinical Medicine
Background:
- Pediatric migraine prevalence is high, but its clinical course remains poorly understood, with conflicting prior research.
- Previous studies often focused on outpatient populations, leaving the outcomes for severe pediatric migraine cases unclear.
- This study addresses the need for clarity on the long-term prognosis of severe pediatric migraine managed in emergency settings.
Purpose of the Study:
- To evaluate the 10-year outcomes of pediatric migraine patients initially admitted to an emergency department.
- To compare the long-term prognosis of this emergency-admitted cohort with outpatient populations.
- To identify potential predictors influencing the long-term persistence of migraine in children.
Main Methods:
- Recruited 80 children (mean age 8) diagnosed with migraine via International Classification of Headache Disorders criteria in 2012.
- Followed up with 48 (60%) of these patients in 2022 via telephone and email questionnaires.
- Utilized logistic regression to analyze the association between prognostic factors (e.g., family history, sleep disorders) and migraine persistence.
Main Results:
- Of the 48 followed patients, 31 (65%) had persistent migraine, while 17 (35%) achieved remission over 10 years.
- Parental neurologic disorders (OR 9.34) and patient sleep disorders (OR 13.18) were significant predictors of persistent migraine (p < 0.01).
- Other investigated factors did not significantly influence long-term migraine prognosis.
Conclusions:
- Pediatric migraine patients initially seen in an emergency department demonstrate a favorable long-term prognosis, similar to outpatient cohorts.
- Familial neurological comorbidity and sleep disorders are identified as unfavorable prognostic factors for pediatric migraine.
- This study provides valuable insights into the long-term trajectory of severe pediatric migraine cases presenting to emergency services.
Background:
Despite its high prevalence, the clinical course of pediatric migraine has not been fully understood, and previous studies present conflicting results. We present here the findings of a 10-year follow-up study involving children with severe migraine pain admitted to our emergency department. Furthermore, all studies were carried out on selected outpatient clinical case studies. Our aim was to evaluate a population of migraine children admitted to an emergency department because of increased severity or frequency of pain or even because of very anxious parents concerning their child's headache in order to describe their long-term outcomes, whether it differed from that of outpatient populations and to identify possible predictors of prognosis.
Methods:
We recruited 80 subjects with migraine headaches (mean age 8 years with a range of 4-14 years, 50% females), attending the baseline examination of a population admitted for a headache to the Emergency Department in the first half year of 2012. Of the 80 subjects, 48 (60%) were eligible for follow-up in 2022. We included in our study only patients diagnosed with migraine, according to the diagnostic criteria of the International Classification of Headache Disorders. All were contacted by telephone, and a semi-structured questionnaire was provided to them by email. The association between several possible prognostic factors (gender, familiar neurologic disorders, prenatal and perinatal disorders, social activities, sleep disorders, etc.) and the long-term persistence of migraine headaches were explored using logistic regression analysis.
Results:
Of 48 subjects with migraine headaches at baseline, 31 (65%) had persistent migraine, and 17 (35%) experienced remission. The preliminary results showed that the presence of neurologic disorders in parents (p < 0.01-odds ratio 9.34 (2.53-41.64) and sleep disorders (p < 0.01-odds ratio 13.18 (2.25-252.74) significantly predicted the 10-year persistence of migraine headaches, while the other considered predictors were found not to influence prognosis.
Conclusions:
To our knowledge, this was the first study conducted on a selected pediatric population upon admission to the emergency room. Our study suggests that a population of pediatric migraine selected for admission to the emergency department also shows a favorable long-term prognosis, like the studies conducted in the outpatient sample. Familial neurological comorbidity and sleep disorders were unfavorable factors for predicting good outcomes.
