Factors Influencing Migraine Recurrence After Infusion and Inpatient Migraine Treatment in Children and Adolescents.
OBJECTIVE
To evaluate factors that influence migraine recurrence after outpatient infusion or inpatient treatment for intractable migraine.


BACKGROUND
Recurrence of migraine after acute treatment in an infusion center or an inpatient setting is not well documented in children and adolescents. Given the multifactorial pathogenesis of migraines, multiple factors may influence migraine recurrence. It has been reported that treatment with steroids may reduce the risk of migraine recurrence. The efficacy of steroids as a therapeutic adjunct has not been established. Studies in the adult population have yielded conflicting results.


METHODS
This study is a retrospective chart review of patients presenting for treatment of an intractable migraine to the outpatient infusion unit or inpatient unit at Cincinnati Children's Hospital Medical Center (CCHMC). Data collected included: age, gender, location of treatment (outpatient, inpatient), migraine duration, diagnosis, severity, the addition of steroids to treatment protocols, and recurrence of migraine at 48 and 72 hours after discharge. Data were analyzed using Fisher's exact tests, logistic regression with backward elimination for variable selection, and least squares means slicing with associated odds ratios.


RESULTS
Charts from 207 pediatric patients were analyzed. Using logistic regression analysis: location, gender, diagnosis, and age were all found to be significant predictors of migraine recurrence (P < .05). Patients treated in the inpatient setting were significantly less likely to experience recurrence compared to patients treated in an outpatient infusion unit (OR = 0.32; 95% CI 0.17-0.61, P = .0002). Male patients with a diagnosis of episodic migraine were significantly less likely to experience recurrence than male patients with chronic migraine (OR 0.17; 95% CI 0.04-0.73; P = .0074). The inclusion of steroids in this study population showed no significant reduction in migraine recurrence. The probability of recurrence decreased with age for episodic migraine patients, while the probability increased with age for chronic migraine patients.


CONCLUSIONS
Recurrence is an important consideration when treating intractable migraines. Age, gender, diagnosis, and location of treatment correlate with migraine recurrence, but the inclusion of steroids does not. Considering these factors in the management of migraines may improve the outcome of these patients and reduce the risk of recurrence.
University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Katherine M
KM
Cobb-Pitstick
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Andrew D
AD
Hershey
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Hope L
HL
O'Brien
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Marielle A
MA
Kabbouche
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Susan
S
LeCates
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Shannon
S
White
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Polly
P
Vaughn
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Paula
P
Manning
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Ann
A
Segers
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Judith
J
Bush
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Paul S
PS
Horn
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Joanne
J
Kacperski
D000293:Adolescent; D000328:Adult; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage*; D008881:Migraine Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D008776:Methylprednisolone Hemisuccinate; D003907:Dexamethasone
children; headache; migraine; recurrence; steroids