Abstract Details

Title Disparities in Pediatric Headache and Migraine Diagnosis and Treatment in the Emergency Department

Topic Headache

Presentation(s) S41 - Emergent Sciences and Top Headache Research (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Background

Diagnostic workup and treatment for headache or migraine in the pediatric emergency department (ED) may vary by race and ethnicity. Prior social disparities research has not explored differences in pediatric headache diagnosis in this setting which could impact care.

Objective To identify racial/ethnic disparities in testing, treatment, and diagnosis of headache and migraine in the pediatric ED.

Design/Methods We identified ED visits with a primary diagnosis of headache or migraine from the Pediatric Health Information Systems database between 2016-2021, excluding diagnoses suggesting secondary headache. We compared rates of diagnosis, testing, and treatment between non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Latino (HL) children and adolescents.

Results Across 142,250 visits (60% female), NHW children comprised 41.1% of visits, NHB 24.2%, and HL 27.4%. Migraine was diagnosed more often in NHW (45.5%) compared to NHB (28.4%) and HL (28.5%) children; NHB (67.3%) and HL (67.5%) were disproportionately diagnosed with non-specific headache (NHW: 52.3%; p<.001). Adjusting for diagnosis, insurance, and other demographic traits, NHW children received more MRI scans (6.7% [95% CI: 4.7-9.4%] vs. NHB 4.0% [2.8-5.6%] and HL 3.7% [2.8-4.9%]; p=0.005), blood tests (25.0% [20.5-30.2%] vs. NHB 21.2% [18.4-24.3%] and HL 21.9% [19.6-24.4%]; p=.013), and intravenous medications (54.2% [50.2-58.1%] vs. NHB 44.2% [40.9-47.6%] and HL 43.7% [39.0-48.5%]; p<.001).

Conclusions NHW children were more likely to receive testing and intravenous medications compared to children of color during ED headache visits. Race and ethnicity appear strongly associated with diagnosis of migraine vs. unspecified headache which could point to healthcare access or diagnostic biases among other factors. This likely impacts interpretation of research centered on visits with a migraine diagnosis. Such disparities in disease management may contribute to overall undertreatment and underdiagnosis of pediatric headache, particularly for children of color. Future research should investigate the validity of using diagnostic codes to select children with migraine compared to alternative methods.

Authors/Disclosures
Danielle J. Kellier PRESENTER	The institution of Ms. Kellier has received research support from National Institute of Neurological Disorders and Stroke.
Marissa Anto, MD (The Children's Hospital of Philadelphia, Dept of Neurology)	Dr. Anto has nothing to disclose.
	No disclosure on file
Christina Szperka (Pediatric Headache Program and Department of Neurology, Perelman School of Medic)	No disclosure on file
Kendall Nash, MD (UCSF)	Dr. Nash has nothing to disclose.
Melissa Hutchinson, MD (ICON)	Dr. Hutchinson has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Katz, Korin, Cunningham Attorneys At Law.
Elizabeth M. Wells, MD (Children'S National Medical Center)	The institution of Dr. Wells has received research support from National Institute of Allergy and Infectious Diseases.
	No disclosure on file
Nicholas S. Abend, MD, FAAN (Children's Hospital of Philadelphia)	Dr. Abend has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Epilepsy Foundation. The institution of Dr. Abend has received research support from NIH. The institution of Dr. Abend has received research support from PCORI. Dr. Abend has received publishing royalties from a publication relating to health care.
Ricka Messer, MD (Children'S Hospital Colorado)	Dr. Messer has nothing to disclose.
Jamie L. Palaganas, MD, FAAN (Pediatric Neurology of NYC)	Dr. Palaganas has nothing to disclose.
Juan Piantino, MD (Oregon Health And Science University)	Dr. Piantino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Applied Cognition.
	No disclosure on file
Craig A. Press, MD, PhD (Children's Hospital of Philadelphia)	Dr. Press has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Marinus Pharmaceuticals. Dr. Press has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Law Firms. Dr. Press has received research support from Marinus Pharmaceuticals. Dr. Press has received research support from Pediatric Epilepsy Research Foundation. Dr. Press has received research support from NIH.