How general practitioners treat migraine in children--evaluation of a headache guideline.
BACKGROUND
Migraine is a common illness in children associated with a negative impact on the quality of life. In the Netherlands, treatment of migraine is commonly performed by general practitioners (GPs). The migraine guideline of the Dutch College of General Practitioners recommends inactivity and acetaminophen in patients with migraine who are younger than 18 years of age.


OBJECTIVE
The aim of our study was to evaluate the pharmacological treatment of migraine in children by GPs before referral to the hospital. Our objective was to answer the following questions. First, are GPs inclined to prescribe medication not listed in the Dutch College of General Practitioners Guideline? Second, which clinical characteristics are associated with the use of medication not listed in this guideline?


METHODS
In this retrospective cross-sectional study, prescribed medication and migraine characteristics were investigated in Dutch migraine patients (age <18 years), using hospital records and a paper-and-pencil questionnaire.


RESULTS
A total of 223 children were included. Medications not listed in the guideline were used in 41.3% of the patients before referral. In children younger than 12 years, the use of medication not listed in the guideline was associated with an older age, when compared with children who were treated according to the guideline. In the group of patients older than 11 years, the use of medication not listed in the guideline was associated with a longer history of migraine and a longer duration of the migraine attacks.


CONCLUSIONS
Medications not listed in the GPs guideline were used in a large portion of the patients younger than 18 years with migraine who were referred to secondary care.
Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
Ilse F
IF
de Coo
Gosse
G
de Jong
Ronald
R
Zielman
Jan S P
JS
van den Berg
D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D000700:Analgesics; D000082:Acetaminophen
children; general practitioner; guidelines; migraine; pharmacological treatment