Diagnostic testing and treatment of pediatric headache in the emergency department

David C. Sheridan, Garth D. Meckler, David M. Spiro, Thomas K. Koch, Matthew L. Hansen

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

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 340â€̂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.

Original languageEnglish (US)
Pages (from-to)1634-1637
Number of pages4
JournalJournal of Pediatrics
Volume163
Issue number6
DOIs
StatePublished - Dec 1 2013

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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