Laird Harrison

November 03, 2016

SAN FRANCISCO — Increased use of drugs has failed to stem the tide of children admitted to hospitals for headaches, researchers say.

"I think this suggests that we are not adequately treating their headaches," Michelle Perry, MD, from the Children's Hospital of Pittsburgh UPMC in Pennsylvania, told Medscape Medical News.

Dr Perry presented the finding here at the American Academy of Pediatrics (AAP) 2016 National Conference and Exhibition.

National data from the National Hospital Ambulatory Medical Care Survey and the Pediatric Health Information System show an increase in headache visits and admissions during the past 20 years, Dr Perry and colleagues found. So they decided to burrow into the data for their own emergency department.

They analyzed medical records of patients aged 4 to 18 years who had visited the department from January 2007 to December 2014.

They found that the number of headache visits increased 130% and the number of admissions increased 440%. By comparison, the total number of pediatric emergency department visits increased by only 30% in that time.

Table. Adjusted Headache Visits and Admissions by Year

Year Adjusted Headache Visits Adjusted Headache Admissions Adjusted Headache Admission Rate
2007 770.6 78.0 10.1%
2008 617.5 80.0 12.7%
2009 968.4 113.7 11.7%
2010 1003.2 165.0 16.5%
2011 1298.6 217.6 16.8%
2012 1439.6 260.9 18.1%
2013 1220.0 216.0 17.7%
2014 1773.8 421.6 23.8%
Total 9091.6 1552.8


The researchers randomly selected 50 charts to review in more detail for each year.

Throughout the study period, 20.9% of girls were admitted compared with 11.8% of boys. But this difference, and other demographics, did not change over time.

On the other hand, the way the emergency department responds to pediatric headaches has changed, the researchers found.

In 2007, 76% received pharmacologic therapy compared with 84% in 2014, a statistically significant change (P = .049). The most significant increase was in the use of diphenhydramine (multiple brands).

The use of CT decreased from 34% in 2007 to 18% in 2014. The change resulted from a deliberate policy at the hospital, which is trying to reduce patients' exposure to radiation from CT, said one of Dr Perry's coauthors, Robert W. Hickey, MD, also from the Children's Hospital of Pittsburgh.

Although the use of MRI increased modestly during this time, the proportion of patients with headache who underwent any sort of imaging decreased.

Nothing in the records explains why so many more children are turning up at emergency departments with headaches, said Dr Perry. But the researchers have some theories they want to investigate.

"We suspect this is a manifestation of rising levels of stress in our pediatric patients," she said. "Headaches have been associated with stress, and a lot of other indicators of stress in children have risen over time, including abdominal pain and depression and anxiety."

The researchers have also looked at some other factors that might be related, Dr Hickey told Medscape Medical News.

"When we've looked at the literature, tobacco and bullying have not increased," he said. "Of those things, only caffeine seems to be increasing. The data on physical activity are mixed."

He speculated that increased awareness of concussions might also have contributed to the rise in headache visits.

The finding "highlights the need for better outpatient treatment, or seeing headache specialists more frequently in the office, or seeing the primary pediatrician," Jennifer Shu, MD, of the Children's Medical Group in Atlanta, Georgia, told Medscape Medical News.

She hoped the researchers will investigate whether children are going to emergency departments because their headaches are severe or whether they don't have access to outpatient care. "Or are they just choosing to go to a place that's open at a time that's convenient to them?"

Dr Hickey, Dr Perry, and Dr Shu have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2016 National Conference and Exhibition: Abstract 319802. Presented October 21, 2016.

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