P0611 - Trends in Migraine Headache Treatment with DHE and Outcomes in Pediatric Hospitalized Patients

Introduction
Migraine headache is a common pediatric disorder, frequently leading to hospital admission. Inpatient MHA treatment is complex, including fluid resuscitation and a variety of medications (NSAIDS, antiemetics, magnesium, steroids and ergot alkaloids). DHE is frequently used to treat patients with severe Migraine headache. In adults, DHE is shown to be effective in relieving Migraine headache and preventing relapses, however efficacy has not been systematically studied in children.

Objective
The objectives of this study were to describe national trends in the use of DHE, and the role of DHE on trends in length of stay (LOS) of pediatric Migraine headache inpatients.

Methods
This retrospective cohort study examined Migraine headache patients admitted to 51 tertiary care children’s hospitals between 2010 and 2018. Data (demographics, DHE treatment, LOS ) were extracted from the Pediatric Health Information System (PHIS) database, for patients, aged 1-18 years, with ICD 9 and 10 codes for MHA as the principal diagnosis. Linear and logistic regression examined trends in the use of DHE and LOS . The study was approved by our institutional review board.

Results
Study subjects included a total of 22,276 Migraine headache inpatients with mean (SD) age 13.6 (3.5) years. The majority were female (72%), identified as white race (75%) and non-Hispanic (87%) ethnicity. Yearly rates of DHE use increased significantly (43% in 2010 to 63% in 2018: p<0.0001). No change was detected in overall LOS (mean [SD] of 2.2 [1.75] days). LOS for patients receiving DHE was longer then for patients not receiving DHE (with DHE; 2.42 [1.92] vs no DHE; mean [SD] 1.9 [1.5] days); however, for patients receiving DHE, LOS decreased on average 0.04 days/year. LOS was constant for patients without DHE (Figure 1).

Discussion/Conclusion
Despite limited data on efficacy for pediatric Migraine headache patients, DHE usage rates significantly increased during the study period. The longer LOS for patients receiving DHE may be due to reservation of it’s use for patients with recalcitrant Migraine headache. The declining trend in LOS for patients receiving DHE may indicate broader use of the drug in patients with less severe Migraine headache, earlier onset of use during the hospital stay or superior efficacy of this medication.
Further prospective studies are needed to estimate direct effects of DHE on outcomes for children hospitalized with Migraine headache and to develop safe and effective treatment protocols.