Brain imaging and prophylactic therapy in children with migraine: recommendations versus reality

• Published in: The Journal of pediatrics Vol. 143; no. 6; pp. 776 - 779
• Main Author: Schor, Nina Felice
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-12-2003; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; Brain - diagnostic imaging; Brain - pathology; Child; Child, Preschool; Female; Guideline Adherence; Humans; Male; Medical sciences; Migraine Disorders - diagnosis; Migraine Disorders - prevention & control; Neurology; Practice Guidelines as Topic - standards; Radiography; Referral and Consultation - standards; Retrospective Studies; Vascular diseases and vascular malformations of the nervous system; CHP; ANA; MRI; EEG; Human; Pediatrics; Nervous system diseases; Migraine; Central nervous system; Cardiovascular disease; Recommendation; Cerebral disorder; Encephalon; Vascular disease; Prevention; Pain; Treatment; Central nervous system disease; Medical imagery; Child; Cerebrovascular disease
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1067/S0022-3476(03)00578-X

To determine the concordance between referring physician behavior and published criteria for performance of imaging studies and institution of prophylactic therapy, respectively, in children referred to an academic children's hospital headache clinic.
A retrospective review of the records of 106 consecutive patients referred to an academic children's hospital headache clinic.
Approximately half of patients referred to the clinic had already had head computed tomography or magnetic resonance imaging ordered by the referring doctor and performed before their clinic appointment. However, using published criteria, only 10% of patients seen in the clinic would have required an imaging procedure before institution of therapy. The referring physician had initiated treatment with daily prophylactic medications for headache in more than 30% of patients before their clinic appointments, of whom 89% were on appropriate medications at age-appropriate and weight-appropriate doses. Half of these children exhibited a positive response to this medication before being seen by the consulting neurologist. However, more than 60% of the children actually met the criteria for recommending prophylactic therapy.
Imaging is more frequently obtained and prophylactic therapy less frequently implemented by the referring physician than would be indicated by published recommendations.