Beyond the Guidelines: A Narrative Review of Treatments on the Horizon for Migraine in Children and Adolescents.

Migraine is common in children and adolescents and can cause significant disability. There are relatively limited evidence-based treatment options available, especially when compared with treatment of migraine in adults. The Pediatric Research Equity Act requires the study of a new drug or biologic in pediatric populations. As such it is mandatory that the newest migraine treatment options available for adults be evaluated in children and adolescents. It will take years before results from clinical trials in pediatric patients become available. In the meantime, there is eagerness among clinicians to seek out the existing evidence that may help provide clarity on utilization of the newer migraine therapies in children and adolescents because many of the currently available, guideline-recommended treatments do not provide benefit for all patients. In this narrative review, the literature regarding onabotulinumtoxinA, neuromodulatory devices, calcitonin gene-related peptide (CGRP) monoclonal antibodies, 5-hydroxytryptamine (1F) agonists (i.e., ditans), and CGRP small-molecule receptor antagonists (i.e., gepants) for the treatment of migraine in children and adolescents will be summarized.

Approach to the Diagnosis of Pediatric Headache.

Headache in children and adolescents is a common symptom that can be worrisome to patients, their parents and clinicians due to the myriad of underlying etiologies, both benign and life-threatening. The evaluation of headache must be directed primarily to exclude secondary causes. A detailed headache history, recognition of headache patterns and red flags and thorough physical and neurological examinations are essential in the diagnosis; and identifies patients requiring further workup. Considerations for neuroimaging and ancillary testing are also discussed.

Implementation of a data accuracy plan to improve data extraction yield in the Axon Registry®.

OBJECTIVE: To conduct a data quality improvement project to improve the quality measure data mapping and to measure key phrase logic in the Axon Registry.® METHODS: Prior validation analysis of the Axon Registry identified 2 main areas for remediation: methodology for mapping data from electronic health record (EHR) into the registry clinical data record (CDR) and key phrase logic for each measure. Practice groups participating in Axon Registry and 6 Axon Registry quality measures were selected for intervention. Mapping of measure elements and measure performances for each of the selected measures and practices were reviewed before intervention. The Data Accuracy Plan (DAP) was performed, and documentation data and visit data counts and data yield after intervention were calculated and analyzed. RESULTS: Documentation data and visit data counts and data yield increased for all 6 quality measures and all practices in the DAP. Increase in documentation data count ranged from 815 to 15,782 occurrences, while visit data count increase ranged from 519 to 16,383 visits. Average data yield range was 7.22% to 33.46% before intervention and increased to a range from 15.34% to 74.40% after intervention. CONCLUSION: There was substantial improvement in the accuracy of data extraction for quality measure elements after intervention to improve methodology for mapping EHR data into CDR and key phrase logic. Implementation of changes and continued review of data mapping and data dictionary are important to ensure accurate measure performance and to improve reliability and validity of Axon Registry data.