Management of Childhood Migraine by Headache Specialist vs Non-Headache Specialists

Radhika Gutta, Kelly J. Valentini, Gunjanpreet Kaur, Ahmad A. Farooqi, Lalitha Sivaswamy

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: This study aims to compare the management practices of a headache specialist with non-headache specialists in the treatment of children with migraine. The use of appropriate rescue medications and prophylactic agents, application of neuroimaging, and short-term outcomes are compared in children treated by the two groups of physicians. Methods: A retrospective cohort study was conducted by utilizing the electronic medical records of children 3-18 years of age with migraine, who were evaluated at a tertiary care children's hospital from 2016 to 2018. Results: Of the 849 patients who met the study criteria, 469 children were classified as having chronic migraine or high-frequency episodic migraine and were followed-up on at least 1 occasion by the neurologists. Imaging was obtained in 66.5% of all children with migraine. The headache specialist used 5-HT agonists (“triptans”) for migraine management in 56.7% (76/135) of cases compared to non-headache specialists who prescribed them in 28.7% (96/334) of cases (P <.001). Of the children with chronic migraine, the headache specialist evaluated 135 patients while the non-headache specialists treated 334 children. Non-headache specialists prescribed prophylaxis in the form of natural supplements more frequently (63.8% of cases) compared to the headache specialist (38.5% of children) (P <.001). Moreover, prophylaxis with prescription drugs was utilized more often by headache specialist (66.7%) than non-headache specialists (37.4%) (P <.001). Conclusions: Imaging appears to be commonly recommended by both headache specialists and non-headache specialists in children with migraine. The headache specialist was more likely to use triptans as rescue medications for pediatric migraine. Outcomes in the short-term were not statistically different whether children were being managed by the headache specialist or the non-headache specialists.

Original languageEnglish
Pages (from-to)1537-1546
Number of pages10
JournalHeadache
Volume59
Issue number9
DOIs
StatePublished - Oct 1 2019

Keywords

  • headache specialist
  • imaging
  • migraine
  • pediatric
  • prophylaxis

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