Management of Pediatric Migraine: Headache vs Non-Headache Specialists

A physician examining a child
A physician examining a child
Headache specialist was more likely to use triptans, while non-headache specialists and the headache specialist started prophylaxis at similar rates in eligible participants.

Both headache specialists and non-headache specialists are likely to recommend imaging in children with migraine, but headache specialists are more likely to prescribe triptans as rescue medications, according to a study published in Headache. Overall, the short-term outcomes were not statistically different between children with migraines who were treated by a headache specialist vs children treated by non-headache specialists.

This retrospective cohort study was designed to compare the management approach for children with migraine of a single headache specialist in a practice with that of the non-headache specialists in that practice. The researchers evaluated the electronic medical records of children ages 3 to 18 years presenting with migraine with aura, migraine without aura, or chronic migraine evaluated in outpatient clinics of the Children’s Hospital of Michigan in Detroit between 2016 and 2018. Specifically, they analyzed data on the use of neuroimaging, prophylactic agents, and rescue medications including short-term outcomes and patient demographics.

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The study population had a statistically equal distribution of different races and urban vs suburban locations. Among the 849 children meeting the study criteria, imaging was obtained for 66.5% (564/849) of patients, 469 of whom were classified as having chronic or high-frequency episodic migraine and were followed at least twice by a headache specialist or non-headache specialists. Among the children with chronic/episodic migraine, 135 were treated by a headache specialist and 334 were treated by non-headache specialists. Children initially evaluated by non-headache specialists and then referred to a headache specialist were not included.

Overall, 30.3% (257/849) of the study cohort was prescribed triptans (5-HT agonists), including 56.7% (76/135) of cases treated by a headache specialist and 28.7% (96/334) of cases treated by non-headache specialists (P <.001). Overall, 82.1% (385/469) of children with chronic/high-frequency episodic migraines were started on prophylaxis. Non-headache specialists were significantly more likely to prescribe natural supplements as prophylactic agents compared with headache specialists (63.7% [212/334] vs 38.7% [52/135], respectively; P <.001). Conversely, headache specialists were significantly more likely to prescribe medications for prophylaxis compared with non-headache specialists (66.7% [90/135] vs 37.4% [125/334]; P <.001). Using the single parameter of headache-free days, no significant differences were noted in the outcomes between patients treated by a headache specialist compared with those treated by non-headache specialists.

The study investigators concluded, “We believe our study sample is a representative of children referred to pediatric hospitals for management of migraine. Since not all children who are seen at tertiary care institutions are evaluated by pediatric headache specialists, we sought to establish differences in treatment plans between the 2 groups of physicians. The generalizability of our study to larger groups of children, who receive care in a variety of medical settings is yet to be established.”


Gutta R, Valentini KJ, Kaur G, Farooqi AA, Sivaswamy L. Management of childhood migraine by headache specialist vs non-headache specialists. Headache. 2019;59(9):1537-1546.

This article originally appeared on Clinical Pain Advisor