Abstract Details

Title Enhancing outpatient infusion with interdisciplinary care to manage refractory pediatric migraine: Preliminary outcomes from “CAMP” (the Comprehensive Aggressive Migraine Protocol)

Topic Headache

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-016

Objective To determine preliminary outcomes from a novel treatment approach to refractory pediatric migraine comprising a combination of outpatient dihydroergotamine (DHE) infusion and interdisciplinary adjunctive care.

Background In a minority of the 10% of children affected by migraine, headaches are refractory to multiple treatments and persist unabated for days and weeks, often resulting in high levels of family distress and increasing utilization of healthcare services. Although limited data are available to guide treatment of refractory migraine in children, aggressive treatment with intravenous dihydroergotamine (DHE) therapy has shown some promise. However, this treatment approach often is implemented in potentially cost-prohibitive inpatient settings and in isolation of nonpharmacological strategies shown to enhance analgesia and functional outcomes.

Design/Methods Our headache program began piloting an outpatient day treatment (“CAMP”) for adolescents with refractory migraine, integrating DHE infusion with interdisciplinary adjunctive nonpharmacological care (e.g., relaxation training, aromatherapy, and massage therapy). Youth were eligible for the program if they were between age 11-18 with frequent or continuous migraine that had failed to respond to several medication trials and at least one other treatment modality (e.g., occipital nerve block). For the current study, electronic health record data on response to treatment were evaluated through 3-month follow-up for the first cohort of 36 patients.

Results On average, headache intensity declined by 58% over 5 days of treatment (P<.01). Headache frequency decreased by a mean of 1.5 days per week (p=.01) through 3-month follow-up, with a 27% reduction in the proportion of patients reporting a continuous headache (p<.01). There also was an average reduction of 76% in school days missed per month (p<.01) and significant reductions in indices of healthcare utilization (healthcare provider calls and ED visits) (p<.01).

Conclusions A multidisciplinary outpatient approach alongside with DHE treatment appears to be an effective choice of treatment for adolescents experiencing refractory migraines.

Authors/Disclosures
Jennifer Bickel, MD, FAAN PRESENTER	Dr. Bickel has received personal compensation in the range of $10,000-$49,999 for serving as a faculty with American College of Heathcare Executives. Dr. Bickel has received personal compensation in the range of $5,000-$9,999 for serving as a Burnout in Oncology Advisory Participant with EMD Serono. Dr. Bickel has a non-compensated relationship as a Editorial Advisory Board with Neurology Today that is relevant to AAN interests or activities. Dr. Bickel has a non-compensated relationship as a Subcommittee member with American Headache Society that is relevant to AAN interests or activities. Dr. Bickel has a non-compensated relationship as a Collaborative member with National Academy of Medicine that is relevant to AAN interests or activities. Dr. Bickel has a non-compensated relationship as a Committee Member with Florida Medical Association that is relevant to AAN interests or activities. Dr. Bickel has a non-compensated relationship as a Board Director with Collaborative for Health and Renewal in Medicine (CHARM) that is relevant to AAN interests or activities.
Subhjit Sekhon	No disclosure on file
Dane Stephens	No disclosure on file
Madeline Boorigie	No disclosure on file
	No disclosure on file

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