STUDY - 83% of Children and Teens Get Suboptimal Acute Migraine Care

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According to a new retrospective study of nearly 40,000 American children ages six to 17. Too many children suffering with migraines are not getting any medication for their pain and too few are receiving care consistent with evidence" based guidelines.

The Study:

Study Background:

"Medication classes effective for treating acute migraine pain in children and teens have been identified. However, there is little research regarding the extent to which health care providers in the US provide care for children and teens with migraine consistent with evidence based guidelines. The current study leveraged EHR"derived (electronic health record) data to assess adherence to guidelines for the acute treatment of pediatric migraine from 2009"2014."1

Study Methods:

  • This retrospective, observational study utilized Epic EHR-­"derived data to identify children and teens ages 6-­"17 who presented with primary migraine and headache across four states in metropolitan and non"metropolitan areas to either primary care, specialty care, or Emergency Department/Urgent Care (ED/UC).
  • Only a child’s first encounter for primary migraine or headache was analyzed.
  • The study included 38,926 unique patients visiting 1,617 unique providers.
  • Medications/medication classes were labeled as evidence"based if the medication has been:
    • designated as Level A or B in published guidelines,
    • considered best evidence in published expert consensus, or
    • had FDA approval.

Study Results:

  • Diagnosis:
    • 18% were diagnosed with migraine,
    • 46% were not formally diagnosed, and
    • 37% were diagnosed with headache.
  • Prescribing:
    • 17,911 (46%) were not prescribed or recommended any medication.
    • 32,659 (84%) were not prescribed or recommended evidence"based medication.
    • Girls were more likely evidence"based medication was higher than boys.
    • Those diagnosed with migraine were more likely to be prescribed evidence"based medicine than those without a diagnosis.
    • Providers in metropolitan regions were less likely to prescribed evidence"based medicine.
    • Providers in an emergency department and urgent care facilities were less likely to prescribe** any** medication relative to those in primary care.

Study Conclusion:

"The current findings indicate that too many children are not getting any medication and too few are receiving care consistent with evidence based guidelines. The best care occurs for children diagnosed with migraine treated in a primary care setting. Five of every six children and teens are receiving suboptimal acute migraine care and as such a significant need exists to increase provider awareness of the benefits of optimal migraine care for children and teens with migraine."1

Researcher Comments:

Lead author Robert A. Nicholson, PhD, LCP, FAHS, Director of Behavioral Medicine, Mercy Clinic Headache Center & Mercy Health Research in St. Louis, commented:

"We discovered that the best care occurs for children diagnosed with migraine who are treated in a primary care setting. We know which medications work best in children and teens with migraine. It’s time that healthcare providers understand that evidence-based care is the right way to go. 'Evidence"based' medications are those designated as Level A or B in published guidelines, have been considered best evidence in published expert consensus, or have FDA approval. These include a class of drugs called triptans, as well as some non"steroidal anti"inflammatory drugs (NSAIDS) and certain analgesic medications."2

Summary, Comments, and Implications:

The results of this study are staggering and disappointing:

  • 46% of these children were not prescribed or recommended any medications at all.
  • 84% were not prescribed or recommended evidence"based medication.

Those are failing grades by any standard. This statement from the study conclusion bears repeating:

"Five of every six children and teens** (83.33%)** are receiving** suboptimal** acute migraine care and as such a significant need exists to increase provider awareness of the benefits of optimal migraine care for children and teens with migraine."

For parents of kids with migraine waiting for Increasing, "provider awareness of the benefits of optimal migraine care for children and teens with migraine," is unacceptable. These parents would be wise to question it if the child's doctor isn't recommending treatment to be used when a migraine occurs AND to ask what evidence supports that treatment.

Dr. David Watson, offered an excellent observation:

"While treatment options for children with migraine are not as plentiful as those for adults, there are many options currently available. It is imperative that children with migraine disorders get adequate treatment to help them now and in their future. Poorly treated migraine generates more migraine."

If you feel your child isn't getting proper and adequate treatment:

  • Remember that there's nothing wrong with getting a second opinion. If a doctor resents your getting a second opinion, that's a sign that you need to find a new doctor.
  • If your child's doctor resents or won't answer your questions, that too is a sign that you need to find a new doctor.

In a perfect world, we could take our children to a doctor, and they'd receive the correct treatment. We don't, however, live in a perfect world, so there are times when we must advocate for our children.


Sources:

1 Nicholson, Robert. "Pediatric Migraine Treatment: Poor Adherence to Evidence Based Acute Medication Guidelines." Research Presentation. 57th Annual Scientific Meeting of the American Headache Society. Washington, D.C. June, 2015.

2 Press Release. "Teens and Younger Children Not Getting Optimal Care for Migraine Pain, says New Study." American Headache Society. Washington, D.C. June 17, 2015.

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