The odds of first-line treatment success in pediatric migraine may be lower in patients who have higher baseline headache frequency and medication overuse headache (MOH), according to a study published in Headache.
The study included participants who had visited the Cincinnati Children’s Hospital Medical Center Headache Center in Ohio for treatment of acute migraine (n=837). The researchers collected data on sex, age, race, primary International Classification for Headache Disorders-III diagnosis, chronic migraine, MOH, headache frequency, month of treatment, headache severity, headache duration, use of acute medication at home in the past 24 hours, and treatment received. Simple logistic regression was used to determine the odds of success of first-line intervention based on participant characteristics.
With a multiple logistic regression model, the odds of first-line treatment success were found to decrease as headache frequency increased (odds ratio [OR], 0.951; 95% CI, 0.934-0.969; P <.0001). The odds of first-line treatment success increased in participants who did not have MOH (OR, 1.528; 95% CI, 1.097-3.714; P =.0469) and who did not receive dexamethasone (OR, 1.528; 95% CI, 1.097-3.714; P =.0469).
“[P]atients with MOH pose a particular challenge in the acute setting given not only the potential for reduced treatment response, but also due to more limited treatment options during withdrawal of the overused medication. This patient subpopulation requires further study, and acute interventions used for migraine may not be the best interventions for patients with comorbid MOH,” concluded the investigators.
Orr SL, Kabbouche MA, Horn PS, et al. Predictors of first-line treatment success in children and adolescents visiting an infusion center for acute migraine [published online June 21, 2018]. Headache. doi:10.1111/head.13340