Opioid Use to Treat Migraine Headaches in Hospitalized Children and Adolescents

Abstract

Objectives: Prescription of opioids to treat pediatric migraine is explicitly discouraged by treatment guidelines but persists in some clinical settings. We sought to describe rates of opioid administration in pediatric migraine hospitalizations.

Methods: Using data from the Pediatric Health Information System, we performed a cross-sectional study to investigate the prevalence and predictors of opioid administration for children aged 7 to 21 years who were hospitalized for migraine between January 1, 2016, and December 31, 2018.

Results: There were 6632 pediatric migraine hospitalizations at 50 hospitals during the study period, of which 448 (7%) had an opioid administered during the hospitalization. There were higher adjusted odds of opioid administration in hospitalizations for non-Hispanic black (adjusted odds ratio [aOR], 1.68; P < .001) and Hispanic (aOR, 1.54; P = .005) (reference white) race and ethnicity, among older age groups (18-21 years: aOR, 2.74; P < .001; reference, 7-10 years), and among patients with higher illness severity (aOR, 2.58; P < .001). Hospitalizations during which an opioid was administered had a longer length of stay (adjusted rate ratio, 1.48; P < .001) and higher 30-day readmission rate (aOR, 1.96; P < .001). By pediatric hospital, opioid administration ranged from 0% to 23.5% of migraine hospitalizations. Hospitals with higher opioid administration rates demonstrated higher adjusted readmission rates (P < .001) and higher adjusted rates of return emergency department visits (P = .026).

Conclusions: Opioids continue to be used during pediatric migraine hospitalizations and are associated with longer lengths of stay and readmissions. These findings reveal important opportunities to improve adherence to migraine treatment guidelines and minimize unnecessary opioid exposure, with the potential to improve hospital discharge outcomes.

FIGURE 1

Variation by hospital in opioid administration for pediatric migraine hospitalizations. There was variation between hospitals in unadjusted rates of opioid administration for pediatric migraine hospitalizations, ranging from 0% to 23.5%, with a median of 6.8% (dotted line).

FIGURE 2

Variation by hospital in adjusted rates of readmissions by opioid administration for pediatric migraine hospitalizations. Each point represents a pediatric hospital. At the hospital level, there was an increase in the adjusted proportion of hospital readmissions (within 30 days) with increasing opioid administration during pediatric hospitalizations for migraine headaches (P <.001).

FIGURE 3

Variation by hospital in adjusted rates of ED revisits by opioid administration for pediatric migraine hospitalizations. Each point represents a pediatric hospital. At the hospital level, there was an increase in the adjusted proportion of ED revisits (within 7 days of discharge) with increasing opioid administration during pediatric migraine hospitalizations (P = .013).