Predictors of Short‐Term Prognosis While in Pediatric Headache Care: An Observational Study

Abstract

Objectives To characterize the short‐term prognosis of a clinical population of pediatric and young adult patients with migraine and explore predictors of clinical worsening while in care. Methods This was a retrospective study of all migraine patients seen at the Cincinnati Children’s Hospital Headache Center from 09/01/2006 to 12/31/2017, who had at least 1 follow‐up visit within 1‐3 months of the index visit analyzed. Included data were: age, sex, race, primary ICHD diagnosis, chronic migraine, medication overuse, history of status migrainosus, BMI percentile, headache frequency, headache severity, PedMIDAS score, allodynia, preventive treatment type, lifestyle habits, disease duration, depressive and anxiety symptoms. Clinical worsening was defined as an increase in 4 or more headache days per month between the index visit and the follow‐up visit. Results Data for 13,160 visit pairs (index and follow‐up), from 5316 patients, were analyzed. Clinical worsening occurred in only 14.5% (1908/13,160), whereas a reduction in headache frequency was observed in 56.8% of visit intervals (7475/13,160), with 34.8% of the intervals (4580/13,160) showing a reduction of 50% or greater. The change in headache frequency was minimal (increase in 0‐3 headaches/month) in 28.7% of intervals (3737/13,160). In the multivariable model, the odds of worsening were significantly higher with increasing age, female sex, chronic migraine, status migrainosus, depressive symptoms, higher PedMIDAS scores, and use of nutraceuticals, whereas the odds of worsening were lower for summer visits, caffeine drinkers, higher headache frequencies, and use of pharmaceuticals. Conclusions The majority of pediatric patients who receive multimodal interdisciplinary care for migraine improve over time. Our findings highlight a set of clinical features that may help in identifying specific factors that may contribute to an unfavorable short‐term prognosis.

The Profile and Prognosis of Youth With Status Migrainosus: Results From an Observational Study

“…This finding underscores the disparity in health care costs and resource utilization in patients with vs without a history of SM and should compel clinicians and researchers to pay particular attention to this subgroup of patients. In addition, as we have previously reported, patients with SM had greater odds of a poor short‐term prognosis, defined as an increase in 4 or more headache days per month in a 1‐3 months follow‐up window . We did not find any statistically significant difference in the other short‐term outcome categories (ie, no difference in the proportion of patients with a 50% or greater reduction in headache frequency, overall reduction in headache frequency or in the proportion with a minimal change in headache frequency).…”

“…We did not find any statistically significant difference in the other short‐term outcome categories (ie, no difference in the proportion of patients with a 50% or greater reduction in headache frequency, overall reduction in headache frequency or in the proportion with a minimal change in headache frequency). As we have hypothesized before, we suspect that SM may be associated with increased headache frequency over time due to repeated exposure to prolonged attacks, and the role that repeated exposure may play in reinforcing the strength of the trigeminovascular pain pathways through sensitization mechanisms.…”

“…Several of the baseline characteristics for this “no follow‐up sample” were significantly different than those of the study sample. A detailed comparison of the characteristics of the study sample as compared to those of the “no follow‐up” sample is available in a prior publication describing this cohort . A history of SM was present in 559 (10.5%) of the patients and was used as an active comparator to the 4757 patients who did not have a historical diagnosis of SM at the initial study visit.…”

“…This was a secondary analysis of data from a retrospective clinical cohort study that aimed to determine predictors of short‐term prognosis in pediatric patients with migraine . Patients seen at the Cincinnati Children’s Headache Center for migraine who had at least 1 short‐term follow‐up interval (1‐3 months) were eligible to be included in this retrospective observational study.…”

“…Daily intake of liquid was dichotomized into either less than 48 ounces per day or greater than 48 ounces per day. Dichotomous variables were also created to define whether or not a patient achieved the following short‐term outcomes: treatment response (defined as 50% + reduction in headache frequency between visits), overall reduction in headache frequency between visits (defined as reduction of 1 or more headache days/month), minimal change in headache frequency between visits (defined as increase in 0‐3 headache days/month), and clinical worsening (defined as an increase in 4 or more headache days/month between visits, as per the definition of clinical worsening used in our prior study).…”