Improving Headache Management in the Pediatric Emergency Department

Jessica L. Hauser, MD, PhD

AHSAM 2020 - Oral session
Published on July 30, 2020


Key messages

  • Children with migraine and headache are a common occurrence in the pediatric emergency department.
  • Triptan therapies have been studied extensively for pediatric migraine in the outpatient setting, but studies are lacking in their use in an emergency setting.
  • Preliminary data analysis indicates the increased use of triptan therapies following the implementation of a clinical standard work pathway, which may lead to more effective treatment of pediatric headache disorders in an emergency setting.

Key messages

  • Children with migraine and headache are a common occurrence in the pediatric emergency department.
  • Triptan therapies have been studied extensively for pediatric migraine in the outpatient setting, but studies are lacking in their use in an emergency setting.
  • Preliminary data analysis indicates the increased use of triptan therapies following the implementation of a clinical standard work pathway, which may lead to more effective treatment of pediatric headache disorders in an emergency setting.

Background

What do we already know about this topic?

  • Headaches are a common presenting complaint of children seen in the pediatric emergency department (ED).1
  • The goal of headache treatment is fast, effective relief of pain with minimal side effects.
  • Children commonly respond to oral analgesics, such as ibuprofen, and triptan therapies.
  • In adults, optimal efficacy of triptans are associated with early use (within an hour of headache onset), but pediatric patients often present after their headaches have persisted for hours, if not days, and home treatments have failed.1-3
  • Triptans are not commonly used for children in the ED and there is a lack of pediatric studies on their use in an ED setting.
  • Intranasal sumatriptan has the potential to be an effective first-line treatment in pediatric patients in the ED.

How was this study conducted?

  • A retrospective study of electronic medical records of all children six years and older diagnosed with migraine or headache treated according to the Seattle Childrens Hospital Clinical Standard Work Migraine Pathway from 2016 to 2020.
  • Collected data includes patient demographics, pain scores throughout the visit, medications and times they were given, disposition and readmission to the ED.
  • Analyses includes descriptive statistics and adjusted linear regressions to quantify correlations between pain scores and interventions.

 

Figure: SCH clinical standard work pathway

Findings

What does this study add?

  • Preliminary analysis demonstrated that approximately 40% of patients receive sumatriptan in the ED.
  • The implementation of the clinical standard work pathway for headache management has lead to a significant increase in the number of patients prescribed sumatriptan on discharge.
  • Analyses are ongoing.

Perspectives

How does this study impact clinical practice?

  • The final data set could lead to improved patient care for children visiting the pediatric department with migraine or headache, and increased understanding of pediatric headache medicine.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Jessica L. Hauser, MD, PhD
Resident Physician, Child Neurology PGY4
University of Washington, Seattle Children’s Hospital
Seattle, Washington

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

1. Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015;135:232-238.

2. Patniyot, I.R. and Gelfand, A.A. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache: The Journal of Head and Face Pain 2016;56:49-70.

3. Goadsby, P., Zanchin, G., Geraud, et al. Early vs. Non-Early Intervention in Acute Migraine — ‘Act When Mild (AwM)’. A Double-Blind, Placebo-Controlled Trial of Almotriptan. Cephalalgia 2008; 28: 383–391.



Headache
Pediatrics


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