Opioid Prescription Rates for Pediatric Headaches Vary by Provider Specialty

girl talking to her doctor
girl talking to her doctor
Investigators examined opioid prescribing trends in children and adolescents with primary headaches during ambulatory and emergency department visits.

Opioid prescriptions for pediatric patients with headache are low but vary considerably by provider specialty and medical setting, according to a study published in the Journal of Pediatrics.  

To examine opioid prescription frequency for pediatric patients with headache by provider specialty and medical department, researchers relied on information gathered from a retrospective cohort study that took place between 2012 and 2015. The new study included 8878 children who had visited the emergency department (ED) and 42,842 children who had ambulatory care visits because of headache. All participants were aged between 7 and 17 years.

In an ED setting, 3.9% of visits included an opioid prescription for pediatric patients, compared with 1.0% in an ambulatory setting. However, the prescription dose was higher in the ambulatory setting than the ED setting (103.5 MME vs 72.9 MME; P =.002). ED opioid prescriptions decreased from 5.1% in 2012 to 3.5% by 2015, but the prescription rate in the ambulatory setting did not change throughout the study period. In both ED and ambulatory care, opioid prescriptions were less likely under a pediatrician’s care (20.8% vs 9.7%, P <.001, and 32.7% vs 24.9%, P =.001, respectively), demonstrating a 58% opioid prescription risk reduction. Compared with white patients, some groups, including Hawaiian/Pacific Islanders, Asians, and Hispanics, were less likely to receive an opioid prescription (−1.41%, −1.22%, and −0.96%, respectively). Researchers could find no differences in opioid prescribing rates when comparing female and male patients.

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Researchers conclude that opioid prescribing rates for pediatric patients with headache are low but vary significantly by medical setting and specialty. They state that opioid prescriptions for children with headache coming from nonpediatricians are a “potential target for quality improvement efforts.”


Meckler GD, Sheridan DC, Charlesworth CJ, Lupulescu-Mann N, Hyunjee K, Sun BC. Opioid prescribing practices for pediatric headache [published online 2018]. J Pediatr. doi: 10.1016/j.jpeds.2018.08.078.