Migraine headaches in children are poorly treated

Doctors in St. Louis, MO examined how well headaches are treated in children. There has been little research about how well doctors in the US care for children and teens with migraine and if the treatment is consistent with evidence-based guidelines. They also assessed how often opioids (narcotics) are prescribed for children with migraines. The study used Electronic Health Record data to look at how almost 40,000 children and teens with migraine who presented to primary care providers, specialty care, or Emergency Room or Urgent Care (ER/UC) across four states in metropolitan and non-metropolitan areas were treated from 2009-2014.

The results showed that among children and teens presenting for care for migraine or likely migraine, nearly half (46%) were not prescribed or recommended any medication. Only one in six (16%) were prescribed or recommended an evidence-based medication. Among those who received medication, nearly one in six (16%) were prescribed an opiod (narcotic), and these numbers are even higher among teens 15-17.

The findings also revealed that the odds of getting an evidence-based medication were significantly higher if migraine was diagnosed, and the odds of getting any medication (evidence-based or not) were higher in non-metropolitan areas. Children and teens treated in a specialty care setting or the ER/UC were twice as likely to be prescribed an opioid than if treated in primary care.

The authors concluded that “Too many children who present for migraine or likely migraine are not getting any medication for their pain. Too few are receiving care consistent with evidence-based guidelines. And far too many are being prescribed an opiod. Five out of six children and teens are receiving suboptimal migraine care. A significant need exists to increase doctor awareness of the benefits of optimal migraine care and the potential dangers of prescribing opioids for children and teens with migraine.”

Guidelines issued by many medical organizations call for the use of ibuprofen as the first line treatment, however most children with severe migraines need to take a triptan. Triptans include sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), and four other similar drugs. Rizatriptan has been shown to be effective in children as young as 6, while other triptans have been approved for children older than 12. It is very likely that, just like in adults, some children respond better to one triptan and several triptans may need to be tried to find the best one. Just because the FDA approved one triptan for children above the age of 6 and another above the age of 12, it does not mean that there is a significant difference among the seven available triptans. These are safe drugs that have been in use for over 20 years and several of them are available in Europe without a prescription.