Children from underrepresented groups get fewer migraine diagnoses, tests, imaging

Key takeaways:

• Researchers analyzed more than 5,700 headache visits to Children’s Hospital of Philadelphia between 2016 and 2020.
• Non-Hispanic Black children received more opioids and barbiturates compared with white patients.

DENVER — Children from underrepresented groups with migraine received fewer diagnoses, imaging, tests and medication compared with their white counterparts, according to a poster at the American Academy of Neurology annual meeting.

“Previous work has shown that migraine is substantially underdiagnosed, and there’s a disparity in ... non-Hispanic Black children compared to white children,” Christina L. Szperka, MD, MSCE, a pediatric neurologist and director of the pediatric headache program at Children’s Hospital of Philadelphia, told Healio. “That is based on billing diagnosis.”

Szperka and colleagues sought to examine racial and ethnic disparities in migraine diagnosis along with management within an ED by utilizing a natural language processing model to identify migraine independent of billing diagnosis.

The model was employed to identify migraine in headache-related visits at Children’s Hospital’s ED (sensitivity of model: 0.85; specificity: 0.69), trained on clinical notes for first-time visits of patients aged 5 to 17 years who presented with a headache as chief complaint between January 2016 and February 2020. From 5,702 headache visits, the model identified 2,569 visits for migraine (median age 13.2 years; 40.6% boys), with 32% yielding a migraine diagnosis.

Researchers calculated risk ratios for migraine billing diagnosis, testing and treatment for non-Hispanic Black and Hispanic/Latino patients compared with non-Hispanic white patients, adjusting for demographics and medical comorbidities.

In the analysis set, 48.5% of patients were non-Hispanic Black, 35.6% were non-Hispanic white, 10.9% were “other” and 5% were Hispanic/Latino.

Results showed that a lower proportion of children from underrepresented groups received migraine diagnoses (non-Hispanic Black vs. non-Hispanic white: RR = 0.8 [95% CI, 0.71-0.92]; Hispanic/Latino vs. non-Hispanic white: RR = 0.72 [0.55-0.95]). A lower proportion of non-Hispanic Black children received any blood tests (Non-Hispanic Black: RR = 0.81 [0.72-0.95]; Hispanic/Latino: RR = 1.01 [1-1.19]), brain MRI scans (Non-Hispanic Black: RR = 0.81 [0.64-0.98]; Hispanic/Latino: RR = 1.29 [0.92-1.61]), or IV medications (Non-Hispanic Black: RR = 0.78 [0.72-0.85]; Hispanic/Latino: RR = 1 [0.94-1.03]). Data also showed that non-Hispanic Black children received more opioids and barbiturates for treatment compared with non-Hispanic white children.

“We are not diagnosing migraine appropriately,” Szperka noted. “We are missing some children who we think probably have migraine. Our treatment of children is different by race and diagnosis. We don’t fully understand the ‘why’ of that.”