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Headache Cases Increase Sharply at Pediatric ED

PITTSBURGH – Emergency departments appear to be treating more young people with headaches than ever before, according to new research seeking to document the trend.

In a presentation at the American Academy of Pediatrics (AAP) 2016 National Conference & Exhibition in San Francisco, researchers from Children's Hospital of Pittsburgh of UPMC reported that, between 2007 and 2014, pediatric ED visits for headaches at their facility doubled from 2% to more than 4%.

During the same time period, according to the research presented by primary study author Michelle Perry, MD, a pediatric resident, the admission rate for children with headache more than doubled from 10% of headache visits in 2007 to 24% in 2014.

For the study, researchers extracted information from the electronic medical record to analyze ED visits for headache pain in young people 4 to 20 years of age, from 2007 to 2014. After random selection of 50 headache visits per year, the study team examined patient data, focusing on variables such as age, gender, race, ethnicity, chief complaint, head injury within 48 hours, history of concussion, and past medical history.

Results indicate that, of 325,172 pediatric ED visits, 10,342 (3.2%) had an ICD-9 code for headache, and 2,247 (21.7%) of headache visits resulted in admission. Headache visits increased 111%, from 896 visits in 2007 to 1,887 visits in 2014, according to the report, although total pediatric ED visits increased only 30%.

Meanwhile, the admission rate for headache increased 187%, with 156 admissions (17.4% of headache visits) in 2007 and 448 admissions (23.7% of headache visits) in 2014.

Study authors point out that management of headache over time differed in two ways:

  • The frequency of head computed tomography (CT) decreased from 34% in 2007 to 18% in 2014; and
  • The frequency of pharmacological therapy increased from 76% of patients receiving medications in 2007 to 88% in 2014.

"Overall, we are performing fewer computed tomography scans, which spares our children from receiving radiation exposure," said study co-author Regina Toto, MD, pediatric chief resident at Children's Hospital of Pittsburgh. “At the same time, we are providing more medications to children with headaches than we have in the past."

Adding that "it is not uncommon to see patients and parents that have missed significant amounts of school or work because of chronic headaches,” study authors conclude that additional research is needed to determine the cause of the increased rates of visits and admissions as well as to develop more effective treatment strategies for these children.

"Our findings show a worrisome trend, and we need to figure out why so many children are ending up in hospitals with headaches," Toto emphasized.

PDMR - Pediatric Emergency Medicine Reports-hz-v3