Demographics, Characteristics of Youth Receiving Migraine Treatment at Infusion Center

A retrospective chart review examining demographic characteristics of children and adolescents receiving infusions at an outpatient center for prolonged headache found that their migraines were more disabling and resulted in lower quality of life than those who did not seek treatment at a center.

Approximately 10% of youth have recurrent headaches, with migraine being the most common; left untreated, migraine may progress to status migrainosus, a debilitating condition of prolonged duration, high pain severity, and significant disability.

Status migrainosus is a migraine attack lasting more than 72 hours and is considered a complication of migraine. It can occur in individuals with episodic or chronic migraine, and prevalence rates for both children and adults are currently unknown. Treatment of status migrainosus varies, and treatment could take place in an emergency department (ED), as an inpatient in a hospital, or, less frequently, in an outpatient infusion center.

The most common classes of medications used to abort a migraine include non-steroidal anti-inflammatory agents (NSAIDs), triptans, acetaminophen, antihistamines, and dopamine receptor antagonists.

The first part of the study included a chart review of all patients between the ages of 6 and 19 years treated in an outpatient headache infusion center. Patients with all types of headache diagnoses were included in the analyses, and there were no requirements for headache frequency or severity. Patients were also not excluded for having other medical conditions or psychiatric comorbidities.

Secondly, a subset of patients comprised the treatment group; they completed a behavioral health evaluation. The control group consisted of children of a similar age (birthdate within 6 months) and gender and were not seeking infusion treatment.

A total of 284 patients were included (n = 227 receiving infusion treatment and n = 57 controls).

Variables included patient demographics, headache type and characteristics, and scores on the Pediatric Quality of Life Inventory (PedsQL), Functional Disability Inventory (FDI), Pediatric Pain Coping Inventory (PPCI), and the Behavior Assessment System for Children — Second Edition (BASC-2).

Patients were primarily female (224/286; 78.9%), Caucasian (254/286; 90.1%), and had a mean age of 15 years. There were 460 visits to the infusion center for headache treatment from 230 unique patients between June 2014 and August 2016.

The mean age of patients receiving infusion was also 15 years; they were also largely Caucasian and female.

Patients had the following headache diagnosis prior to their first infusion treatment: migraine (with and without aura, 33.8%), headache attributed to traumatic injury to the head (acute and chronic combined, 22.9%), daily headache (chronic daily headache and new daily persistent headache, 14.8%), chronic migraine (5.3%), and tension-type headache (2.1%).

The diagnoses most associated with the infusion visit were: status migrainosus (38.3%), headache attributed to traumatic injury of the head (acute and chronic combined, 22.5%), prolonged migraine (with and without aura, 18.5%), daily headache (chronic daily headache and new daily persistent headache, 13.2%), chronic migraine (4.4%), and tension-type headache (1.8%).

Of the children receiving an infusion, 70% were on preventive medication for their headaches at the time of their first infusion .

In looking at the psychosocial characteristics, the authors found a difference in the PPCI Distraction subscale, χ 2(1) = 3.7, P = .054, with a mean rank score of 61.90 for the treatment group and 50.21 for the control group.

A statistically significant difference was noted on the Social Support subscale, χ²(1) = 10.6, P = .001, with a mean rank score of 65.92 for the treatment group and 46.26 for the control group. Results also indicated a statistically significant difference in disability scores, χ² (1) = 10.0, P = .002, with a mean rank FDI score of 66.83 for the treatment group and 47.34 for the control group.

Patients in the infusion group also reported lower quality of life on the PedsQL Total score (F[1, 109] = 5.0, P = .028; partial η ² = 0.044), and on the Physical (F[1, 109] = 7.9, P = .006; partial η ² = 0.069) and School (F[1, 109] = 4.6, P = .035; partial η ² = 0.041) subscales.

No significant differences were found on the BASC-2.

The researchers noted that both study measures used to assess physical functioning (FDI and PedsQL- Physical scale) show congruent findings for the treatment group, underscoring the impact on limiting activities of daily living, including the ability to function at school.

However, pain coping methods are important to consider in studying patients receiving infusion treatments, the authors wrote. It is possible that seeking treatment at an infusion center could be a way of justifying an absence away from school for a student who is struggling and a way to reduce school-related stress.

In addition, the PPCI Distraction subscale and a statistically significant difference on the Social Support subscale (higher scores in the treatment group) suggest that social support and distraction are not frequently used to cope with the pain. These pediatric patients may not actively refocus their attention away from the headache, factoring into higher perceived pain intensity and the need for more intensive treatment. It is also possible that headache

patients seeking infusion treatment do not believe in their ability to face their pain and maintain their functionality, although it is possible that those patients who sought infusion treatment did so due to their pain being more severe than the control group.

The researchers said that developing concrete treatment plans and goals combined with bio-behavioral therapy are necessary to reduce functional disability and increase quality of life among these patients. Awareness of pain-related coping strategies may help healthcare providers tailor treatment recommendations and develop or refine cognitive-behavioral headache treatment techniques, they wrote.

Reference

Woods K, Ostrowski-Delahanty S, Cieplinski T, Winkelman J, Polk P, Victorio, MC. Psychosocial and demographic characteristics of children

and adolescents with headache presenting for treatment in a headache infusion center [published online April 22, 2019]. Headache. doi: 10.1111/head.13537.