We’ve talked in the past about how far behind we are in the field of migraine treatment for children. Far behind where we should be, and far behind where we are in treatment for adults.
A new study sponsored by the Migraine Research Foundation has brought the discussion to the forefront yet again.
The study used Electronic Health Record data to see how 40,000 teens and children with migraine were treated. The news was generally not good.
First, of those who were actually prescribed medication, 15.8% were prescribed an opioid. Considering the wide range of treatments available today, and the many problems with using opioids as treatment for migraine, this number is very high. (Note: This is not to suggest that opioid treatments are never appropriate. Only that the evidence increasingly shows that they should be way down the list of things to try. Prescribing so much of this type of medication indicates that treating children and teens with migraine is many years, even decades, behind where it should be.)
It should be noted that opioids were far more likely to be given in the emergency room. Emergency room health care workers may still not be aware of some of the other options available to quickly treat a severe migraine attack.
Next, only 16.1% were prescribed an “evidence based” medication. Again, we’re talking about medication that has good scientific evidence behind it.
Now at first glance, I’m not quite as worried about this statistic. There are many excellent non-drug treatments for children, including biofeedback and supplements. I would not necessarily want doctors to jump to medication first-thing.
However, if I’m reading the numbers correctly, this actually represents 35% of children and adolescents who were prescribed medication.
In other words, the vast majority were not being prescribed the best medication to fight migraine.
Finally, only 46% were prescribed medication at all.
Again, I’m not necessarily worried that doctors are not going to drugs as the first and best option. However, these numbers and years of experience in this field tell me that a good number of doctors are probably telling patients to “just live with it”, when better options are available.
An interesting side note to the study. The researchers compared treatment in metropolitan and non-metropolitan areas, and discovered to their surprise that the doctors in the non-metropolitan areas were doing a better job at prescribing medications with good evidence behind them. So just because you’re in the city doesn’t mean you have better options – that small-town doctor seems to be doing a great job.
It is very difficult for doctors to stay up with the latest research in every area. All right, impossible. This is not an anti-doctor study by any means (and again, there is a lot this study doesn’t tell us).
However, it is a reminder that migraine in children and teens is a serious issue which needs to get more attention. If you’re a doctor, this is certainly something to think about. If you’re a parent, you can focus on your child and take responsibility to make make sure they are getting good treatment.