Improving Acute Treatment of Pediatric Primary Headache Disorders With a Novel Headache Treatment Center: Retrospective Review of Preliminary Outcomes

Abstract

Objective: To determine preliminary outcomes of targeted headache treatments provided at a novel outpatient acute care pediatric headache treatment center. Background: Limitations exist in acute management of pediatric headaches, including inadequate access to specialty headache therapies and headache specialists in acute settings, variable success of emergency room treatments, and omission of comfort measures. An outpatient acute headache care clinic (the “Headache Treatment Center”) was strategically initiated at a Midwestern pediatric academic hospital to provide acute and targeted headache therapies for children with active headaches. Methods: We conducted a retrospective chart review of 154 visits from September through November 2018 of patients ages 7-18 years visiting the Headache Treatment Center. Results: On average, headache intensity (measured on an 11-point pain numeric rating scale) decreased after interventions used in the Headache Treatment Center (mean change = 2.85 ± 2.81, P < .05, Cohen d = 1.01). Large effect sizes for reducing headache intensity were observed for pericranial, occipital/auriculotemporal, and occipital nerve blocks, Cohen d = 1.56, 1.64 and 1.02, respectively. Large effect sizes for reducing headache intensity also were observed for a transcutaneous supraorbital nerve stimulator device (Cefaly) (Cohen d = 1.02), acupuncture (Cohen d = 1.09), and intravenous migraine cocktails (Cohen d = 0.91-1.34). Conclusion: Targeted headache therapies to abort pediatric primary headaches as part of a novel headache clinic model may be beneficial for short-term management.

Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache

“…These characteristics may explain why infusion centers have been shown to be effective for treating pediatric headache disorders [11,20]. Our study also found the outpatient infusion care model to be effective for treating headache disorders.…”

Headache in Children and Adolescents

“…Because the placebo response is likely driving most, if not all, of the improvements seen when patients take pill-based preventives, in the author’s opinion, clinicians should focus on shared decision making, choose interventions that minimize side effects as first-line treatments, and use honest strategies that promote treatment expectancy for patients (eg, being cautiously optimistic about treatment potential given high reported placebo response rates) 117 . A list of preventive interventions that are used in practice in children and adolescents with migraine is provided in table 9-7 119-131 …”

Beyond the Guidelines

“…There were no marked adverse events; inability to tolerate the device was reported in at least 1 patient. 30 The device delivers an electrical signal transcutaneously to the trigeminal nerve through the supraorbital nerve, thus modulating the pain pathways involved in migraine. 31,32 By stimulating the trigeminal nerve, the eTNS device was noted to be an effective, safe, and tolerable acute and preventive treatment of migraine in adults with suggested benefits for acute use in pediatrics.…”

“…31,32 By stimulating the trigeminal nerve, the eTNS device was noted to be an effective, safe, and tolerable acute and preventive treatment of migraine in adults with suggested benefits for acute use in pediatrics. [28][29][30] The eCOT-NS device was cleared for the acute treatment of migraine in adults in 2021. 33 It is not cleared for use in patients younger than 18 years.…”