To examine the associations between patient and clinical factors, including obesity, and acute care for pediatric migraine.

Headaches are the most common chronic neurological condition affecting children.  Obesity may be a risk factor for migraine headache, number of migraine attacks and migraine severity. The relationship between obesity and health care utilization for migraine has not been studied in children.

We performed a retrospective cohort study of the Nationwide Emergency Department Sample (NEDS) from 2007-2010, the largest dataset of emergency department (ED) visits in the United States.  The NEDS includes data on patient and hospital characteristics, diagnoses, procedures, and ED visit disposition.  Our study examined individuals ages 3-20 with a primary ED visit diagnosis of migraine headache. Hospital admission was the primary study outcome. Obesity, sociodemographic and hospital characteristics were examined as predictors of hospitalization using multivariable logistic regression models which also included a measure for pediatric comorbid disease.

We identified 361,394 pediatric patient visits to the ED with a principal migraine diagnosis, most frequently involving female (71.1%), privately insured (47.3%) individuals between the ages of 15 and 18 (42.4%) from lower/ lower-middle income neighborhoods (59.0%). Obesity was coded as a secondary diagnosis in 1,842 encounters.  Hospital admission for migraine was less likely after ED visits involving children from low income neighborhoods (AOR, <25^th versus >75^th percentile:0.61, 95%CI 0.49-0.76) or with Medicaid insurance (versus private, AOR 0.66, 95%CI 0.58-0.75).  Pediatric migraine patients with a secondary diagnosis of obesity had a substantially increased odds of admission (AOR 9.3, 95%CI 6.96-12.42).

High socioeconomic status and obesity are associated with emergent hospitalization for migraine in children. Further study is needed to determine whether weight management can improve pediatric migraine outcomes, and to better understand the socioeconomic care disparity.