Improving Acute Treatment of Pediatric Primary Headache Disorders With a Novel Headache Treatment Center: Retrospective Review of Preliminary Outcomes

J Child Neurol. 2021 Jan;36(1):54-59. doi: 10.1177/0883073820952997. Epub 2020 Sep 1.


Objective: To determine preliminary outcomes of targeted headache treatments provided at a novel outpatient acute care pediatric headache treatment center.

Background: Limitations exist in acute management of pediatric headaches, including inadequate access to specialty headache therapies and headache specialists in acute settings, variable success of emergency room treatments, and omission of comfort measures. An outpatient acute headache care clinic (the "Headache Treatment Center") was strategically initiated at a Midwestern pediatric academic hospital to provide acute and targeted headache therapies for children with active headaches.

Methods: We conducted a retrospective chart review of 154 visits from September through November 2018 of patients ages 7-18 years visiting the Headache Treatment Center.

Results: On average, headache intensity (measured on an 11-point pain numeric rating scale) decreased after interventions used in the Headache Treatment Center (mean change = 2.85 ± 2.81, P < .05, Cohen d = 1.01). Large effect sizes for reducing headache intensity were observed for pericranial, occipital/auriculotemporal, and occipital nerve blocks, Cohen d = 1.56, 1.64 and 1.02, respectively. Large effect sizes for reducing headache intensity also were observed for a transcutaneous supraorbital nerve stimulator device (Cefaly) (Cohen d = 1.02), acupuncture (Cohen d = 1.09), and intravenous migraine cocktails (Cohen d = 0.91-1.34).

Conclusion: Targeted headache therapies to abort pediatric primary headaches as part of a novel headache clinic model may be beneficial for short-term management.

Keywords: adolescents; children; headache; migraine; outcome; pediatric; treatment.

MeSH terms

  • Acupuncture Therapy / methods*
  • Adolescent
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Child
  • Diphenhydramine / therapeutic use*
  • Dopamine Antagonists / therapeutic use
  • Female
  • Headache Disorders, Primary / therapy*
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Ketorolac / therapeutic use*
  • Male
  • Nerve Block / methods*
  • Prochlorperazine / therapeutic use*
  • Retrospective Studies
  • Transcutaneous Electric Nerve Stimulation / methods*
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal
  • Dopamine Antagonists
  • Hypnotics and Sedatives
  • Diphenhydramine
  • Prochlorperazine
  • Ketorolac