Background: Migraine headache (MHA) is a common pediatric disorder, which frequently leads to hospital admission. Inpatient MHA treatment involves ever-increasingly complex treatment plans, including fluid resuscitation and a variety of medications. Severe Migraine headache may require more aggressive therapy such as dihydroergotamine (DHE) and sphenopalatine ganglion (SPG) block that may prolong hospital stay and increase cost. While the Center for Medicare and Medicaid services (CMS) computed that the rate of rise of overall health care expenses was 3.9 to 6.2 % per year(1) between the years 2010-2017, local experience predicted a greater rate of increase for patients admitted with Migraine headaches.The objectives of this study were to describe national trends in admission rates, length of stay, and estimated admission costs for patients with Migraine headaches at Children’s Hospitals across the United States and to compare the rise in cost of hospitalization for these patients with national trends.
Methods: We performed a retrospective cohort study of patients admitted to 51 tertiary care children’s hospitals in the USA using Pediatric Health Information System (PHIS) database. We included patients, aged 1-18, with ICD 9 and 10 codes for Migraine headache as the principal diagnosis, hospitalized between 2010 and 2018. Institutional IRB approved this study. We analyzed the data using SAS/STAT® software
Results: Study subjects included a total of 22,276 MHA inpatients with mean age 14.1 years. The majority were female (16030; 72%). Most of the patients identified as white race (78%) and non-Hispanic (85%) ethnicity. Absolute number of hospital admissions for Migraine headaches have almost doubled since 2010 (Figure 1). The average length of stay over the study period was 2.2 days (range 2.07-2.35 days; p value 0.15). Average cost of hospitalization was $7465( range of $5113( in the year 2010) to $10,822(in the year 2017), p value <0.0001).While length of stay for Migraine headaches has not significantly changed over the past decade ; the rate of increase in cost of hospitalization for patients with Migraine headaches has greatly exceeded the rate of increase in overall healthcare costs ( based on Center for Medicare and Medicaid studies data(2))especially from 2010 to 2017 as shown in Figure 2.
Conclusions: An increasing number of children across the country are hospitalized each year for the treatment of Migraine headache.While length of stay has not significantly changed, the cost associated with inpatient treatment of MHA has increased in excess of the rate of increase in overall healthcare costs. Further studies are needed to ascertain potential causes for this disproportionate rise in cost of care for children with Migraine headache in the inpatient setting.
