Yvette Goodridge, DNP, PNP

Abstract:

Pediatric chronic headaches are a common complaint and one of the primary reasons for seeking medical treatment. Headache medications have limited effects on children with chronic headaches. Few studies examined the effects of complementary alternative medicine (CAM) to optimize pain management in children with chronic headaches. The objective is to evaluate whether CAM [acupuncture, cognitive behavioral therapy (CBT), and biofeedback therapy (BFT)] reduces headache frequency and pain scores when used in addition to medications in children with chronic headaches.

This was a retrospective review of electronic health records from September 2016-January 2020 to examine the effects of CAM. Inclusion criteria: children 10 to 18 years, diagnosis of chronic headaches, and received one or more CAM types. Demographics and clinical information related to headaches were collected (number of headaches per week, pain scores on 0-10 scale, and change in pain quality). Quantitative follow-up telephone surveys were conducted to evaluate the effectiveness and continued use of CAM. Descriptive statistics, Chi-square (categorical variables), Wilcoxon Signed Rank Test (ordinal comparisons) of headache frequency and pain quality and paired t-tests used to evaluate pain scores before and after CAM.

Children (n=78; 14 ± 2.4 years) were mostly female (81%), Hispanic (45%), and had chronic migraines (47%). Children received acupuncture (68%) or combined acupuncture and CBT (25%). Pain scores (n=40) were significantly different before (7.0 ± 2.0) and after (2.53 ± 3.1, p = 0.03) treatment. Children who received acupuncture (n=28) had a significant decrease in pain scores before (7.0 ± 1.6) and after (1.8 ± 1.6, p < 0.001) treatment. Children (n=11) who received the combined acupuncture and CBT also indicated a significant decrease in headache pain scores before (7.5 ± 2.1) and after (4.6 ± 3.4, p = 0.02). The survey (n=20) indicated that more than half (55%) agreed that CAM was helpful; the majority (61%) reported relief for two months. Ninety percent were not currently using CAM due to insurance or scheduling conflicts (60%).

Findings from this project indicate that CAM had significant effects on the improvement of headache frequency and pain scores in both children receiving acupuncture or combined acupuncture and CBT. However, insurance and conflict in schedules were significant barriers to continuing use of CAM. Prospective studies are needed to minimize barriers to receiving CAM and evaluate whether CAM may optimize pain control and decrease use of pain medications in children with chronic headaches.

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