title: Diagnostic testing and treatment of pediatric headache in the emergency department.
abstract: OBJECTIVE
  To describe the variability in diagnostic testing and treatment of headaches in children presenting to the emergency department (ED) with use of a nationally representative sample.
  
  
  METHODS
  This was a retrospective cohort study using the National Hospital Ambulatory Medical Care Survey during 2005-2009. To assess the use of evidence-based treatment, we analyzed all patients <18 years old in 2 groups: (1) primary discharge diagnosis of headache and (2) discharge diagnosis of migraine.
  
  
  RESULTS
  Four hundred forty-eight sampled ED visits from 2005-2009 represented a national estimate of 1.7 million visits with a discharge diagnosis of headache. A total of 95 visits represented a national estimate of 340 000 visits with a discharge diagnosis of migraine. Median age was 13.1 years and 60% were female with a primary diagnosis of headache. In this group, neuroimaging was performed in 37% of patients and 39% underwent blood tests. Nonsteroidal anti-inflammatory drugs and opioids were most commonly used for treatment. For children with a discharge diagnosis of migraine, approximately 40% of patients received non-evidence-based treatment, most commonly with opioid medications, and >20% of patients underwent computed tomography scanning.
  
  
  CONCLUSIONS
  There is significant variability in the evaluation and treatment of pediatric headache in the ED. Despite evidence-based clinical guidelines for migraine headache, a large number of children continue to receive opioids and ionizing radiation in the ED.
authors: Department of Pediatrics, Oregon Health and Science University, Portland, OR. Electronic address: sheridda@ohsu.edu.
authors: David C
authors: DC
authors: Sheridan
authors: Garth D
authors: GD
authors: Meckler
authors: David M
authors: DM
authors: Spiro
authors: Thomas K
authors: TK
authors: Koch
authors: Matthew L
authors: ML
authors: Hansen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
keywords: CBC; CT; Complete blood cell count; Computed tomography; EBT; ED; Emergency department; Evidence-based treatment; NHAMCS; NSAID; National Hospital Ambulatory Medical Care Survey; Nonsteroidal anti-inflammatory drug