Treatment of children with migraine in emergency departments: national practice variation study

Abstract

Objective: Children with migraine may present to an emergency department (ED) when outpatient management has failed; however, only limited research has examined migraine-abortive medications among children.

Methods: A retrospective chart review of ED presentations for migraine or headache between July 1, 2004, and June 30, 2005, in 10 Canadian pediatric EDs was conducted. A priori, evidence-based treatments were defined as any treatment that was based on high-quality evidence and an absence of opioids as first-line agents.

Results: A total of 2515 records were screened, and 1694 (67.4%) met inclusion criteria. The average age of patients was 12.1 years, 14.5% (95% confidence interval [CI]: 12.1%-17.2%) of patients experienced headache >15 days per month, and 62.6% (95% CI: 55.7%-68.9%) had already used migraine-abortive therapy. Significant variations in practice for all classes of migraine-abortive medications were observed. Dopamine receptor antagonists (prochlorperazine, metoclopramide, or chlorpromazine) (39% [95% CI: 28.4%-50.8%]) and orally administered analgesics (acetaminophen and ibuprofen) (24.5% [95% CI: 23.9%-46.8%]) were prescribed most commonly. Predictors for the use of evidence-based treatment included older age (odds ratio: 1.15 [95% CI: 1.07-1.24]) and a discharge diagnosis of migraine (odds ratio: 1.84 [95% CI: 1.11-3.05]).

Conclusions: Children presenting to EDs for treatment often have frequent attacks and have experienced failure of outpatient, migraine-abortive efforts. Practice variations were impressive for the care of children with migraine in these Canadian EDs.