Association of Psychiatric Comorbidities With Treatment and Outcomes in Pediatric Migraines

Abstract

BACKGROUND AND OBJECTIVES: Migraine headache is a common disorder in pediatrics, sometimes leading to hospital admission. Psychiatric comorbidities are prevalent in adults with migraine headache, but there is limited evidence in the pediatric population. This study aimed to examine the prevalence of psychiatric comorbidity in children hospitalized for migraine headache and assess the association of this comorbid state on treatment interventions and outcomes. METHODS: This multicenter, retrospective cohort study examined data from the Pediatric Health Information System. Subjects included patients aged 6 to 18 hospitalized for migraine headache between 2010 and 2018, excluding those with complex chronic conditions. Associations of psychiatric comorbidity with treatments, length of stay (LOS), cost, and 30-day readmissions were assessed using the Fisher-exact, Wilcoxon-rank-sum test, and adjusted linear or logistic regression models. RESULTS: The total 21 436 subjects included 6796 (32%) with psychiatric comorbidity, with prevalence highest for anxiety (2415; 11.2%), depression (1433; 6.7%), and attention-deficit/hyperactivity disorder (1411; 6.5%). Patients with psychiatric comorbidity were significantly more likely (P < .001) to receive dihydroergotamine (61% vs 54%), topiramate (23% vs 18%), and valproate (38% vs 34%), and have longer mean LOS (2.6 vs 2.0 days), higher average costs ($8749 vs $7040), and higher 30-day readmission (21% vs 17%). CONCLUSIONS: Of children hospitalized for migraine headache, 32% have comorbid psychiatric disorders associated with increased use of medications, longer LOS, and increased cost of hospitalization and readmission. Prospective studies are recommended to identify optimal multidisciplinary care models for children with migraine headaches and psychiatric comorbidities in the inpatient setting.

Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome

“…Similar to the study by Kafle et al (17) on pediatric migraine, we postulated that the effective utility of prophylactic mediations in CVS might influence the risk of repeat admissions. Prophylactic therapy was classified as the use of 1 of 3 medications, cyproheptadine, amitriptyline, or propranolol.…”

“…In a large US database study involving approximately 5.5 million pediatric inpatient hospitalization encounters, mood disorders such as anxiety and depression were significantly associated with higher readmissions in children older than 13 years (20). Similarly, in another national-level study using the Pediatric Health Information System (PHIS) database in pediatric migraine, psychiatric comorbidities were significantly associated with increased medication use, higher healthcare utilization, and increased readmissions (17). Previous studies in both children and adults documented a wide prevalence of psychiatric disorders in CVS (21–27).…”

“…Adults with various chronic disorders have an increased prevalence of psychiatric disorders, and the presence of concomitant psychiatric conditions is associated with substantially increased healthcare resource utilization including a higher proportion of readmissions (7)(8)(9)(10)(11)(12)(13)(14). Similarly, in children, mental health disorders were associated with readmissions in many chronic disorders such as migraine, diabetes mellitus, and asthma (15)(16)(17)(18)(19). In a large US database study involving approximately 5.5 million pediatric inpatient hospitalization encounters, mood disorders such as anxiety and depression were significantly associated with higher readmissions in children older than 13 years (20).…”

Cost-of-illness and Economic Evaluation of Interventions in Children and Adolescents with Chronic Pain

“…In these studies, the samples were predominately White, non-Hispanic. Included pain types were chronic pain without further specification on pain location, 33,38,44,45 chronic headaches or migraine, 4,36,[40][41][42][43] abdominal pain, 4,36,37,39 musculoskeletal pain, 4,46 back or neck pain, 36 and pelvic/perineal pain. 34 The related diagnostic inclusion criteria for these types of chronic pain are displayed in Table 3 as well.…”

“…The diagnostic criteria were described sufficiently in all but one study. 40 The majority of the studies did not perform a sensitivity analysis; this quality criterion was met by only 1 included study. 38 The EEs met an average of 63.4% (SD = 18.9%) of the quality criteria (Table 2).…”