Migraine diagnosis and management in children and adolescents: a primary care study in England

Background Previous work has highlighted that children and adolescents with migraine are underdiagnosed and undertreated in primary care.

Aim To characterise diagnosis and treatment patterns among children and adolescents with migraine in primary care.

Design & setting A retrospective cohort study using the Clinical Practice Research Datalink Aurum.

Method The study cohort included patients aged 6-17 years presenting to primary care practices with headache/migraine in England between September 2012 to May 2023 (“index” event). Prescribed medications, primary care consultation and referral rates 12 months after index were investigated. Medication overprescription was defined as per the ICHD-3 definition of medication overuse headache.

Results 246 744 children (6-12 years) and adolescents (13-17 years) were observed attending primary care with headache/migraine. The majority of headache was unclassified (67.6%), particularly in children compared to adolescents (77.6% v 57.9%). Primary headache disorders accounted for 31.3% of headache presentations, higher in adolescents compared to children (40.9% v 21.4%). Migraine was the most common primary headache disorder (N=67,059, 86.9%), constituting the final sample for subsequent analyses.

Acute medication was prescribed to 28,478 (45.7%), and preventive medication for 17,153 (27.5%). Paediatric clinics referral rates were 14 referrals per 100-person-years. Medication overprescription was observed in 26.0% of triptan users.

Conclusion Most headache cases presenting to primary care in England remain unclassified, particularly in children (6-12 years). Compared to previous research, more children and adolescents were prescribed medication for migraine in primary care and fewer were referred to secondary care. Evidence of suboptimal medication use was still observed in this study.