The demographic characteristics and migraine diagnosis of pediatric patients with headache were found to be associated with the use of evidence-based medicine and prescriptions for opioids and barbiturates as first-line treatment, according to a study published in Cephalagia.

Characteristics of patients (ages 6-17 years) and provider/encounter for an initial visit for migraine or primary headache obtained from the patient’s electronic health record for the 2008 to 2014 period were examined for this retrospective study. The primary outcome was use by the healthcare provider of evidence-based medicine. Secondary outcomes included overall prescriptions and opioid/barbiturate prescriptions. Hierarchic linear modeling was used to determine the association between study outcomes and level-1 characteristic (ie, patient demographics, insurance type) and level-2 characteristics (ie, provider treatment setting, encounter diagnoses). A total of 38,926 patients (mean age, 12.1 years) and 1617 providers were identified. Of these, 17.7% of patients were diagnosed with migraine, and 16.1% received evidence-based therapy. Older children (odds ratio [OR], 1.07; P <.001), female gender (OR, 1.14; P <.001), and a migraine diagnosis (OR, 4.71; P <.001) were found to be associated with a higher likelihood of receiving treatment derived from evidence-based medicine. A total of 54.0% of patients received a prescription of any kind, of which, 15.8% were for opioids/barbiturates.

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Patients were found to be more likely to receive a prescription for opioids/barbiturates if they were treated in an emergency department/urgent care center. In addition, patients who were older (OR, 1.14; P <.001), girls (OR, 1.16; P <.001), white (OR, 1.18; P <.001), and those with government insurance (OR, 1.12; P= .036) or no insurance (OR, 1.22; P =.003) vs private insurance were more likely to be prescribed an opioid/barbiturate.

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“Future research should focus on interventions intended to improve education regarding [evidence-based medicine] for pediatric migraine to pediatric providers and assessing the impact of that education,” the researchers noted.


Seng EK, Gelfand AA, Nicholson RA. Assessing evidence-based medicine and opioid/barbiturate as first-line acute treatment of pediatric migraine and primary headache: a retrospective observational study of health systems data. [published online February 20, 2019]. Cephalagia. doi:10.1177/0333102419833080

This article originally appeared on Clinical Pain Advisor