Opioid Use to Treat Migraine Headaches in Hospitalized Children and Adolescents

Abstract

Prescription of opioids to treat pediatric migraine is explicitly discouraged by treatment guidelines but persists in some clinical settings. We sought to describe rates of opioid administration in pediatric migraine hospitalizations. METHODS:Using data from the Pediatric Health Information System, we performed a crosssectional study to investigate the prevalence and predictors of opioid administration for children aged 7 to 21 years who were hospitalized for migraine between January 1, 2016, and December 31, 2018.RESULTS: There were 6632 pediatric migraine hospitalizations at 50 hospitals during the study period, of which 448 (7%) had an opioid administered during the hospitalization. There were higher adjusted odds of opioid administration in hospitalizations for non-Hispanic black (adjusted odds ratio [aOR], 1.68; P , .001) and Hispanic (aOR, 1.54; P 5 .005) (reference white) race and ethnicity, among older age groups (18-21 years: aOR, 2.74; P , .001; reference, 7-10 years), and among patients with higher illness severity (aOR, 2.58; P , .001). Hospitalizations during which an opioid was administered had a longer length of stay (adjusted rate ratio, 1.48; P , .001) and higher 30-day readmission rate (aOR, 1.96; P , .001). By pediatric hospital, opioid administration ranged from 0% to 23.5% of migraine hospitalizations. Hospitals with higher opioid administration rates demonstrated higher adjusted readmission rates (P , .001) and higher adjusted rates of return emergency department visits (P 5 .026). CONCLUSIONS:Opioids continue to be used during pediatric migraine hospitalizations and are associated with longer lengths of stay and readmissions. These findings reveal important opportunities to improve adherence to migraine treatment guidelines and minimize unnecessary opioid exposure, with the potential to improve hospital discharge outcomes.

Rates of Presentation, Treatments and Serious Neurologic Disorders Among Children and Young Adults Presenting to US Emergency Departments With Headache

“…35 Additionally, opioid use has been associated with readmissions and longer lengths of stay among patients admitted with headache. 36…”

Factors Associated With Dermatologic Follow-up vs Emergency Department Return in Patients With Hidradenitis Suppurativa After an Initial Emergency Department Visit

“…For instance, recurrence of HS lesions after I&D occurs in up to 100% of cases . Opioid prescription in the ED may also be associated with ED return, as has been demonstrated for other conditions causing pain . Finally, HS disproportionately affects African American individuals and individuals of lower socioeconomic groups, such as those with Medicaid insurance .…”

“…26 Opioid prescription in the ED may also be associated with ED return, as has been demonstrated for other conditions causing pain. [27][28][29][30] Finally, HS disproportionately affects African American individuals [31][32][33][34][35] and individuals of lower socioeconomic groups, 36 such as those with Medicaid insurance. 8 Thus, suboptimal patterns of health care utilization for HS could contribute to poorer outcomes for these patients of medically disadvantaged backgrounds.…”