TOPLINE

Most children and adolescents in England who presented to primary care with headache were coded as having unclassified headache, with migraine representing more than 25% of presentations. Many were prescribed acute medication within 12 months.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from primary care practices in England to characterise the diagnosis and treatment patterns of migraine among children and adolescents.
• A total of 246,744 children aged 6-12 years and adolescents aged 13-17 years with at least one headache diagnosis between 2012 and 2023 were included.
• Headache events were classified as primary, secondary, or unclassified.
• Medication overprescription was defined as a supply of at least 10 days per month for some medications or at least 15 days per month for others in 3 consecutive months.

TAKEAWAY

• Primary headache disorders accounted for 31.3% of all headache presentations, with migraine representing 86.9% of primary headache disorders, followed by tension-type headache (12.6%). Overall, 67,059 participants (median age, 14 years) received a migraine diagnosis.
• Unclassified headaches were observed more frequently in children than in adolescents (77.6% vs 57.9%), and primary headache disorders were nearly twice as prevalent in adolescents vs children (40.9% vs 21.4%).
• Rates of referral to secondary care services were highest for paediatric clinics (14 referrals per 100 person-years).
• In the 12 months after index, acute medication was prescribed to 50.1% of adolescents and 37.8% of children, and preventive medication was prescribed to 27.5% of patients. The highest rates of medication overprescription were found among users of triptans (26.2%) and opioids (17.4%).

IN PRACTICE

"The present study highlights that underdiagnosis of paediatric migraine persists, despite improvement in the diagnosis of primary headache disorders. These findings highlight a need for clear, practical guidelines for the diagnosis and management of migraine in children and adolescents, to improve clinician confidence, particularly within primary care settings," the authors of the study wrote.

SOURCE

The study was led by David P.B. Watson of the Aberdeen Royal Infirmary in Aberdeen, Scotland. It was published online on June 24, 2026, in BJGP Open.

LIMITATIONS

The study relied on coded medical events and operational definitions. Migraine-related prescribing and healthcare use may have been overestimated as reasons for prescriptions and consultations or referrals were not recorded. Data on over-the-counter and secondary care medications are often not captured, potentially underestimating prescriptions.

DISCLOSURES

This study received funding from Pfizer Ltd. Two authors disclosed receiving consulting fees from Pfizer Ltd. Several authors reported being employees of Pfizer Ltd at the time of the study and holding financial equities in the company. Some others reported working at Adelphi Real World at the time of the study, which received funding from Pfizer Ltd to conduct the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.