Background: Migraine headaches (MHA) are common in children, with severe migraines leading to hospitalization. For children hospitalized with MHA, therapeutic interventions are often directed by subjective descriptors like self-reported pain scores. It has been reported that pain scores have mixed validity especially at younger ages (1–4). Sympathetic response to pain is known to elevate heart rate (HR) and blood pressure (BP); however limited studies evaluating the validity of vital signs as an objective tool for pediatric pain assessment have been done. The objective of this study was to determine if the self-reported pain severity of MHAs in children correlates with fluctuations of HR, systolic BP (SBP), and/or diastolic BP (DBP), providing an objective means of confirming pain severity.
Methods: Retrospective chart review was conducted on all patients between the ages of 6 and 18 who were admitted between 2010 and 2018 with a primary discharge diagnosis of MHA. Patients with an infectious process or complex care needs were excluded. For each patient, up to 10 pain scores with the associated HR, SBP, and DBP (performed within 1 hour of self-reported pains score) were collected. Each combination of vital signs and pain score was labelled as an individual data group. Scatterplots were created to show the relationship between pain scores and individual vital signs. Descriptive statistical tools and Pearson’s correlation tests were used to compare the data groups.
Results: A total of 1,239 patients met inclusion criteria for the study. These patients were predominantly female (76.9%), non-Hispanic ethnicity (76.7 %), and white race (90.9%), with a mean age of 14.1 years. Correlations were found to be very weak between pain scores and HR for all ten data groups (Pearson r = -0.011 to 0.073; Figure 1). For SBP and pain scores, all correlations were very weak (Pearson r = -0.052 to 0.050; Figure 2), and no associations were identified to be statistically significant. Likewise, all correlations were very weak between DBP and pain scores (Pearson r = -0.093 to 0.051; Figure 2).
Conclusions: No significant association was found between self-reported pain score and HR, SBP, or DBP in our study population.. Fluctuations in vital signs may imply the presence of pain, but their validity as a solo metric is not supported by the present study. We recommend that vital signs should be used in combination with other validated pain assessment methods to accurately assess headache severity in pediatric patients. Next steps include study of the correlation of pain scores and vital sign changes by age to see if variability exists between age groups.
