Transition from Pediatric Care to Adult Care in Headache Patients

Abstract

Migraine is a common condition that affects children as they develop into adults. Transition of care from pediatric to adult care has becoming an increasingly popular topic in the medical literature. It has been suggested that discussions between patients, their families and providers should be initiated as early as age 13. Patients who are un or underprepared have poorer outcomes due to increased morbidity and worsening of their medical condition. Many children continue to have migraine into adulthood and if efforts are taken to ensure patients receive appropriate transfer of care, the results can significantly decrease the economic burden of this disease. Keywords: Transition Medicine; Pediatric migraine; Pediatric; Migraine; Migraine in young adultsMigraine is a common disorder that often begins in childhood. More than 6% of adolescents are affected in the United States and worldwide as high as 8% are diagnosed with chronic daily headache [1,2]. The diagnosis of headaches in boys occurs between the ages of 10 and 14 years which is earlier than seen in girls who peak at 14-20 years of age [3]. The prevalence of migraine and probable migraine in adults is estimated to be 16.2% of the US population. The highest burden was seen among women ages 18-44 years. Chronic migraine accounts for over 7% of the migraine population [4]. Despite the high migraine prevalence, many patients are undiagnosed and/or undertreated due to several factors including lack of access to headache specialty care, delayed or misdiagnosis and poor or suboptimal treatment [3]. Young adults or patients transitioning from pediatric to adult care are most vulnerable to these factors since studies show that most patients who present for an initial visit have had symptoms for on average 10 years [5]. Young adults are less likely to be involved in research studies as the average age involving migraine patients describe pediatric or adolescent (up to the age of 17) or adults where the demographic focus is on women where the average or median age is 40 [6]. Unsuccessful transition can lead to worsening of the disease process and poor outcomes [7].Transition medicine has been of increasing interest as advances in medicine has led to patients living beyond what has been once considered childhood disease. Emerging research focused on transition of health care in young adults has been evaluated in several different medical subspecialties including congenital heart disease, diabetes, and cystic fibrosis. Early, aggressive and successful treatment of migraine can lead to remission in 18-34% of adolescents with new onset of migraines [8]. Although remission can be seen in some adolescents, 46% will have their migraines persist, and 20% will develop transforming headache [8,9]. These patients will continue to need ongoing headache care and will need to transition care to an adult provider at the appropriate time. However transition care has yet to be explored in the area of headache medicine [10].There have been several studies attempting to identi...