To determine preliminary outcomes of targeted headache treatments provided at a novel outpatient acute care pediatric headache treatment center.
Background:
Limitations exist in acute management of pediatric headaches, including inadequate access to specialty headache therapies and headache specialists in acute settings, variable success of emergency room treatments, and omission of comfort measures. An outpatient acute headache care clinic (the “Headache Treatment Center”) was strategically initiated at a Midwestern pediatric academic hospital to provide acute and targeted headache therapies for children with active headaches.
Methods:
We conducted a retrospective chart review of 154 visits from September through November 2018 of patients ages 7-18 years visiting the Headache Treatment Center.
Results:
On average, headache intensity (measured on an 11-point pain numeric rating scale) decreased after interventions used in the Headache Treatment Center (mean change = 2.85 ± 2.81, P < .05, Cohen d = 1.01). Large effect sizes for reducing headache intensity were observed for pericranial, occipital/auriculotemporal, and occipital nerve blocks, Cohen d = 1.56, 1.64 and 1.02, respectively. Large effect sizes for reducing headache intensity also were observed for a transcutaneous supraorbital nerve stimulator device (Cefaly) (Cohen d = 1.02), acupuncture (Cohen d = 1.09), and intravenous migraine cocktails (Cohen d = 0.91-1.34).
Conclusion:
Targeted headache therapies to abort pediatric primary headaches as part of a novel headache clinic model may be beneficial for short-term management.
BurchRCLoderSLoderESmithermanTA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies [published correction appears in Headache. 2015 Feb;55(2):356]. Headache. 2015;55(1):21–34.
2.
BachurRGMonuteauxMCNeumanMI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics. 2015;135(2):232–238.
3.
TrottierEDBaileyBLucasNLortieA. Prochlorperazine in children with migraine: a look at its effectiveness and rate of akathisia. Am J Emerg Med. 2012;30(3):456–463.
4.
MauserEDRosenNL. So many migraines, so few subspecialists: analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache subspecialists compared to United States headache demographics. Headache. 2014;54(8):1347–1357.
5.
McCarthyLHCowanRP. Comparison of parenteral treatments of acute primary headache in a large academic emergency department cohort. Cephalalgia. 2015;35(9):807–815.
6.
TrottierEDBaileyBLucasNLortieA. Diagnosis of migraine in the pediatric emergency department. Pediatr Neurol. 2013;49(1):40–45.
7.
Sahai-SrivastavaSDesaiPZhengL. Analysis of headache management in a busy emergency room in the United States. Headache. 2008;48(6):931–938.
8.
MinenMTBoubourAWahnichAGrudzenCFriedmanBW. A retrospective nested cohort study of emergency department revisits for migraine in New York City. Headache. 2018;58(3):399–406.
9.
YoungNSilvermanDBradfordHFinkelsteinJ. Multicenter prevalence of opioid medication use as abortive therapy in the ED treatment of migraine headaches. Am J Emerg Med. 2017;35(12):1845–1849.
10.
ConnellyMGlynnEFHoffmanMABickelJ. Rates and predictors of using opioids in the Emergency Department to treat migraine in adolescents and young adults [published online ahead of print June 22, 2019]. Pediatr Emerg Care. doi:10.1097/PEC.0000000000001851.
11.
CainMRArkiloDLinaberyAMKharbandaAB. Emergency department use of neuroimaging in children and adolescents presenting with headache. J Pediatr. 2018;201:196–201.
12.
EapenAAgarwalRThomasRSivaswamyL. Management of pediatric migraine in a tertiary care versus community based emergency department: an observational pilot study. Pediatr Neurol. 2014;51(5):751.
13.
CharlesJAPeterlinBLRapoportAMLinderSLKabboucheMASheftellFD. Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification. J Headache Pain. 2009;10(4):227–233.
14.
EsparhamAHerbertAPierzchalskiE, et al.Pediatric headache clinic model: implementation of integrative therapies in practice. Children (Basel). 2018;5(6):74.
15.
AllenSMMookadamFChaSSFreemanJAStarlingAJMookadamM. Greater occipital nerve block for acute treatment of migraine headache: a large retrospective cohort study. J Am Board Fam Med. 2018;31(2):211–218.
16.
BlumenfieldAAshkenaziANapchanU, et al.Expert consensus recommendations for the performance of peripheral nerve blocks for headaches—a narrative review. Headache. 2013;53(3):437–446.
17.
TaoHWangTDongXGuoQXuHWanQ. Effectiveness of transcutaneous electrical nerve stimulation for the treatment of migraine: a meta-analysis of randomized controlled trials. J Headache Pain. 2018;19(1):42.
18.
ChouDEGrossGJCasadeiCHYugrakhMS. External trigeminal nerve stimulation for the acute treatment of migraine: open-label trial on safety and efficacy. Neuromodulation. 2017;20(7):678–683.
19.
TassorelliCGrazziLdeTommaso, et al.Noninvasive vagus nerve stimulation as acute therapy for migraine: The randomized PRESTO study. Neurology. 2018;91(4):e364–e373.
20.
CameronCKellySHsiehSC, et al.Triptans in the acute treatment of migraine: a systematic review and network meta-analysis. Headache. 2015;55(suppl 4):221–335.
21.
KelleyNETepperDE. Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium. Headache. 2012;52(1):114–128.
22.
KelleyNETepperDE. Rescue therapy for acute migraine, part 2: neuroleptics, antihistamines, and others [published correction appears in Headache. 2012 Mar;52(3):527]. Headache. 2012;52(2):292–306.
23.
RozenTD. Emergency department and inpatient management of status migrainosus and intractable headache. Continuum (Minneap Minn). 2015;21(4 Headache):1004–1017.
24.
KabboucheM. Management of pediatric migraine headache in the emergency room and infusion center [published correction appears in Headache. 2016 Apr;56(4):819]. Headache. 2015;55(10):1365–1370.
25.
WangLPZhangXZGuoJ, et al.Efficacy of acupuncture for acute migraine attack: a multicenter single blinded, randomized controlled trial. Pain Med. 2012;13(5):623–630.
26.
CadyRKSaperJDexterKCadyRJManleyHR. Long-term efficacy of a double-blind, placebo-controlled, randomized study for repetitive sphenopalatine blockade with bupivacaine vs saline with the Tx360® device for treatment of chronic migraine. Headache. 2015;55(4):529–542.
27.
BinfalahMAlghawiEShoshaEAlhillyABakhietM. Sphenopalatine ganglion block for the treatment of acute migraine headache. Pain Res Treat. 2018;2018:2516953.
28.
VerheulWSandersABensingJ. The effects of physicians’ affect-oriented communication style and raising expectations on analogue patients’ anxiety, affect and expectancies. Patient Educ Couns. 2010;80(3):300–306.
29.
HojatMLouisDZMaioVGonnellaJS. Empathy and health care quality. Am J Med Qual. 2013;28(1):6–7.
30.
PatniyotIRGelfandAA. Acute treatment therapies for pediatric migraine: a qualitative systematic review. Headache. 2016;56(1):49–70.
31.
CastarlenasEJensenMPvon BaeyerCLMiróJ. Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: a systematic review. Clin J Pain. 2017;33(4):376–383.
32.
Cobb-PitstickKMHersheyADO’BrienHL, et al.Factors influencing migraine recurrence after infusion and inpatient migraine treatment in children and adolescents. Headache. 2015;55(10):1397–1403.
33.
LiptonRBManackARicciJA, et al.Prevalence and burden of chronic migraine in adolescents: results of the chronic daily headache in adolescents study (C-dAS). Headache. 2011;51:693–706.
34.
RossSWallESchiermanB, et al.Quality improvement in neurology: primary headache quality measures. Neurology. 2015;84(2):200–203.
