Pediatric Migraine Treatment Needs Improvement


Migraine is a common ailment among children and teens, but a new study indicates that too few receive appropriate treatment. This is particularly true in urban areas, according to Robert A. Nicholson, PhD, of Mercy Clinic Headache Center & Mercy Health Research in St. Louis. He presented the information at the recent Annual Scientific Meeting of the American Headache Society.

In a retrospective review that spanned four states and included 5 years of medical records from nearly 40,000 children ages 6 to 17, researchers found that just 16% received evidence-based treatment for acute migraine. Nearly 38% received other medication, and 46% received no medication at all. Overall, girls fared better than boys, with young female migraineurs more likely to receive evidence-based treatment than their male counterparts. Researchers also found that the best care occurred in primary care settings, rather than in emergency departments or urgent care clinics.

Also worrisome, researchers said, is that health care professionals prescribed opioids at the first visit for 1 in 6 children seeking care for migraine or probable migraine. Opioids are not a recommended migraine treatment.

Evidence‐based medication for migraine treatment include triptans, some nonsteroidal anti‐inflammatory drugs (NSAIDS), and certain analgesic medications.

“We know which medications work best in children and teens with migraine,” Dr. Nicholson said. “It’s time that healthcare providers understand that evidence-based care is the right way to go.”

The records also indicated that when children were given a diagnosis of migraine (17.7%) or headache (36.6%), appropriate treatment was more likely to follow. In nearly 46% of the cases, however, no diagnosis was provided.

Commenting on this study, NHF President Arthur Elkind, MD, noted that childhood migraine often has a shorter duration than in adults, and some prescribers may believe medications to be unnecessary or have the potential of creating adverse effects. They may therefore suggest non-pharmaceutical treatments. Apart from those caveats, Dr. Elkind endorsed better professional education in diagnosis and treatment of headache disorders for optimal headache and migraine treatment in the pediatric population.

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