Elsevier

The Journal of Pediatrics

Volume 163, Issue 6, December 2013, Pages 1634-1637
The Journal of Pediatrics

Original Article
Diagnostic Testing and Treatment of Pediatric Headache in the Emergency Department

https://doi.org/10.1016/j.jpeds.2013.07.006Get rights and content

Objective

To describe the variability in diagnostic testing and treatment of headaches in children presenting to the emergency department (ED) with use of a nationally representative sample.

Study design

This was a retrospective cohort study using the National Hospital Ambulatory Medical Care Survey during 2005-2009. To assess the use of evidence-based treatment, we analyzed all patients <18 years old in 2 groups: (1) primary discharge diagnosis of headache and (2) discharge diagnosis of migraine.

Results

Four hundred forty-eight sampled ED visits from 2005-2009 represented a national estimate of 1.7 million visits with a discharge diagnosis of headache. A total of 95 visits represented a national estimate of 340 000 visits with a discharge diagnosis of migraine. Median age was 13.1 years and 60% were female with a primary diagnosis of headache. In this group, neuroimaging was performed in 37% of patients and 39% underwent blood tests. Nonsteroidal anti-inflammatory drugs and opioids were most commonly used for treatment. For children with a discharge diagnosis of migraine, approximately 40% of patients received non–evidence-based treatment, most commonly with opioid medications, and >20% of patients underwent computed tomography scanning.

Conclusions

There is significant variability in the evaluation and treatment of pediatric headache in the ED. Despite evidence-based clinical guidelines for migraine headache, a large number of children continue to receive opioids and ionizing radiation in the ED.

Section snippets

Methods

This is a retrospective cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2005-2009. This study was approved by the Institutional Review Board at Oregon Health and Science University.

The NHAMCS group patients by diagnosis using International Classification of Disease, Ninth Edition codes. We obtained our study population by searching the database for patients with a primary discharge diagnosis of headache or migraine. Our patient population

Results

From 2005-2009, there were 448 ED visits with a primary discharge diagnosis of headache or migraine in patients <18 years old, representing approximately 1.7 million ED visits in the US with a discharge diagnosis of headache or migraine over this time period. The median age was 13.1 years with a female predominance (60%).

Of these 448 ED visits, 95 had a discharge diagnosis of migraine headache, representing a national estimate of 340 000 ED visits. The average age of the migraine cohort was

Discussion

Pediatric headache remains a frequent reason for children to visit an ED, accounting for an annual estimate of >340 000 visits in our cohort. This study describes the ED treatment and diagnostic testing of pediatric headache across the US population.

One interesting finding was the high use of CT in the study population. Recent concern over the effects of ionizing radiation, particularly among children, has been raised.16, 17, 18 More than one-third of our cohort received a CT scan with unclear

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The authors declare no conflicts of interest.

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