Children, Teens with Migraine May Be Receiving Inadequate Care

Results show that pediatric patients may not be receiving migraine care based on evidence-based guidelines.

WASHINGTON — New data presented at the American Headache Society Annual Scientific Meeting suggest that many children and teens with migraine pain are not receiving medication for their pain or care consistent with evidence-based guidelines, and that many are being prescribed an opiate.

“Although there are specific medication classes identified as effective for treating acute migraine pain in children and teens through guidelines, expert consensus, and FDA approval, little work has been done regarding guideline adherence across different treatment settings in the U.S.,” study researcher Robert A. Nicholson, PhD, LCP, FAHS, of Mercy Clinic Headache Center & Mercy Health Research in St. Louis, told Neurology Advisor. “However, based on guideline adherence for adult populations, we suspected that many pediatric patients with migraine or likely migraine were receiving suboptimal care. This mattered to us because consequences of suboptimal migraine treatment include poorer health care quality, higher health care costs, and increased patient susceptibility to disability and medication misuse and decreased quality of life.”

For the retrospective, observational study, Nicholson and colleagues identified children and teens (aged, 6-17 years; mean age, 12 years; 57% female; 78% white) with primary migraine and headache, using data from the Epic Electronic Health Record. In all, 21,015 patients presenting at 1,284 providers were identified.

According to data, nearly half (46%) of patients were not prescribed or recommended any medication, and the vast majority (84%) were not prescribed or recommended evidence-based acute medication, with 16% of patients being prescribed an opioid.

“Five of every six children and teens are receiving suboptimal migraine care, and, as such, a significant need exists to increase provider awareness of the benefits of optimal migraine care and the potential dangers of prescribing opioids for children and teens with migraine,” Nicholson said.

Furthermore, the strongest predictor of patients receiving evidence-based medicine was the child having a migraine diagnosis.

“This tells us that when the provider takes the time to ask the right questions, listen to the patient, and ensure they are getting the right kind of information to establish what kind of headache (migraine or other) the child is having, [they are] more likely [to] prescribe medications ideally suited to treat the child’s pain,” Nicholson said.

In addition, girls were more likely to receive evidence-based medication than boys, and the overall best care occurred in a primary care setting vs. an emergency room or urgent care clinic.

Nicholson commented that parents should advocate for their child to make sure they are receiving the best care possible for their migraine or other headaches.

“Getting care from a health care provider with whom the child has an established relationship [will] make it more likely that migraine care fits within the child’s overall health care,” Nicholson said.


  1. Nicholson RA et al. Abstract 84412. Presented at: American Headache Society Annual Scientific Meeting 2015; June 18-21, 2015; Washington, D.C.