Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Praktijkvariatie in de tweedelijns behandeling van kinderen met hoofdpijn en het gebruik van de PedMIDAS in deze hoofdpijnpopulatie

(2018) Hullegie, M. (Marjolein)

Introduction – Headache is a common phenomenon in children and is one of the top five diseases worldwide that have the most impact on daily life. The aim of this study was to determine what the characteristics of pediatric patients with headache, referred to a secondary clinic, are and which practice variation is seen when it comes to the use of diagnostics and applied treatment advices. In addition it is also investigated whether the PedMIDAS questionnaire can measure the impact of headache in children.
Methods – Data from patients with headache under 18 years referred to the pediatric outpatient clinic of Isala, a large secondary teaching hospital in the Netherlands, were retrospectively collected from the electronic patient files. In a subselection, data on the PedMIDAS were available. Agreement of PedMIDAS was assessed with both the patient recorded painscore (VAS-scale) and a record based severity scale, taking into account frequency, duration, school absence and additional complaints.
Results – We included 810 patients (446 (55%) girls; mean age 10.79 years (SD 3.85)), with a diagnosis of migraine in 41% (n=335). Aside from the finding that boys were more likely to be diagnosed with migraine than girls (49% vs 35%, diff 14%, 95% CI 7%, 21%, p = 0.000) no big differences were found between the children with migraine and non-migraine headache. There was a large difference between the 14 pediatricians in registered diagnosis, medical treatment and requesting additional research (ranging from 0% till 50% (mean 24%)). 14% of the children (n=117) underwent a MRI cerebrum (three children with active pathology). In 18 children chance findings were found on the scan, which did not explain the headache. 157 children completed the PedMIDAS; mean score 38.3 (SD 34.0), associated category ‘moderate’. The internal consistency of the questionnaire was good (Cronbach’s α 0.734). The degree of agreement between the PedMIDAS and the patient based VAS-score and severity scale was moderate (Spearman’s correlation coefficient 0.450 (p = 000) and the ICC 0.524 (p = 000)). The degree of agreement for VAS-score alone was low (Spearman’s coefficient 0,109 (p = 0.177) and ICC 0,166 (p = 0.124).
Conclusion – It is striking that boys are more likely to have migraines than girls. It is also noteworthy that practice variation exists between pediatricians regarding registered diagnosis, prescribed medication and additional research. The PedMIDAS questionnaire seems to be a reliable and valid tool to measure the impact of migraine and non-migraine headache in children, despite having a bad agreement with de VAS-score. The record based severity scale and the VAS-scale seem to additional to each other in order to make a good assessment of the impact.

To top