Evaluation of the pharmacological treatment of migraine in children referred to the neurologist

Introduction: Migraine is a common illness in children. The burden of migraine is high; resulting in a decrease in the quality of life e.g. missing 9 schooldays a year. The guideline “headache” of the Dutch College of General Practitioners (DCGP) recommends treating migraine with rest and acetaminophen. A referral to a neurologist or paediatrician is recommended when the symptoms are worse or if prophylactic treatment is needed. An effective treatment is essential to improve the quality of life in children with migraine. The pharmacological treatment in children with migraine given by general practitioners (GPs), paediatricians and neurologists has never been evaluated in the Netherlands. Material and method: This retrospective cohort study was performed in children less than 18 years of age who were referred to an outpatient department or headache clinic of neurology at a general hospital because of migraine between January 2006 and June 2011. Patient characteristics, diagnosis and pharmacologic treatment were gathered and analysed. The data were obtained by hospital records and a questionnaire. Results: 223 patients were included in this study with a mean age of 12,8 year (range 4,3 to 17,8 years). The younger group of patients (less than 12 years of age) consisted of 41 females and 42 males and the older group (between 12 to 17 years of age) of 86 females and 54 males. Most of the patients (n=170) were referred by a GP and 46 patients by a paediatrician. Medication not listed in the DCGP guideline were used in 21,7 % of the young children and 47,9% of the older children for their migraine before consulting a specialist. After consultation with a paediatrician more patients were using triptans, antiemetics and prophylactic drugs. After consultation with a neurologist an even larger proportion of the patients were using triptans, anti-emetics and prophylactic drugs. Nausea or vomiting was present in about 72% of the children during a migraine attack. However, anti-emetic treatment was only prescribed in a minority of the patients by the GPs, paediatrician, and neurologists. Conclusion: A significant proportion of the children with migraine are using treatment not recommended in the DCGP-guideline before consulting a specialist. After consultation acute and prophylactic treatment were more often used. I would advise to include in the DCGP guideline for the treatment of headache during a migraine attack NSAIDs for both groups of children and also triptans for the children in the older group. Furthermore I would advise to include domperidone in the DCGP guideline for the treatment of nausea and vomiting during a migraine attack in both groups of children.