Volume 40 Supplement 1

70th Congress of the Italian Society of Pediatrics

Open Access

Quality of clinical guidelines in pediatric headache

Italian Journal of Pediatrics201440(Suppl 1):A86

https://doi.org/10.1186/1824-7288-40-S1-A86

Published: 11 August 2014

Background

Headache is a very common complaint in children, and can have a profound impact on school performance [1], being the major cause of absence from school [2], and interfering with other daily activities [3]. The studies based on parental reports may be an unreliable source of information on the frequency of headache in young children; in fact, it has been suggested that almost 36% of the parents of children with headache are unaware of the headache [4]. In any case, the increased incidence over the last 30 years probably reflects the significant changes in children’s lifestyles.

Given the elevated prevalence and the associated high degree of disability, it is not surprising that headache represents an important public health issue with considerable costs for the National Health Care System (NHCS), although, as children are not directly involved in the productivity process, it is not so easy to quantify the enormous, both, direct and indirect NHCS costs in this population [5].

Methods

To assess the appropriateness and uniformity of application of the available pediatric clinical guidelines (CGs) for the diagnosis and treatment of headache in children, It has been conducted a systematic literature search using the following terms: headache, cephalalgia, guidelines and children (MESH or text words). Six CGs containing informations on the diagnosis and management of headache with specific recommendations for children were selected [611]. Eleven neuropediatric centers evaluated, by means of the AGREE II instrument, the quality and the appropriateness of available CGs.

Results

NICE CGs resulted “strongly recommended”, while the French and Danish CGs were mainly “not recommended”. The comparison between the overall quality score of the French and NICE CGs was statistically significant (6.54 ± 0.69 vs 4.18 ± 1.08; p =0.001). A correlation analysis showed a significant association only for the “editorial independence” domain (r = 0.842 p = 0.035). The intra-class coefficients showed that the higher agreement between 11 reviewers was present for the Lewis CGs (r = 0.857) while the lower one for the NICE CGs (r = 0.656).

Conclusions

CGs are definitely scarce and non "homogeneous". A major efforts to update the existing CGs according to principles of the evidence based medicine are needed.

Authors’ Affiliations

(1)
NESMOS Department, Chair of Paediatrics, Pediatric Headache Centre, Paediatric Sleep Centre & Child Neurology, Faculty of Medicine & Psychology, “Sapienza University”, Sant’Andrea Hospital

References

  1. Souza-e-Silva HR, Rocha-Filho PA: Headaches and academic performance in university students: cross-sectional study. Headache. 2011, 51: 1493-1502. 10.1111/j.1526-4610.2011.02012.x.View ArticlePubMedGoogle Scholar
  2. Abu-Arefeh I, Russell G: Prevalence of headache and migraine in schoolchildren. BMJ. 1994, 309: 765-769. 10.1136/bmj.309.6957.765.PubMed CentralView ArticlePubMedGoogle Scholar
  3. Barea LM, Tannhauser M, Rotta NT: An epidemiologic study of headache among children and adolescents of southern Brazil. Cephalalgia. 1996, 16: 545-549. 10.1046/j.1468-2982.1996.1608545.x.View ArticlePubMedGoogle Scholar
  4. Sasmaz T, Bugdayci R, Ozge A, Karakelle A, Kurt O, Kaleagasi H: Are parents aware of their schoolchildren's headaches?. Eur J Public Health. 2004, 14: 366-368. 10.1093/eurpub/14.4.366.View ArticlePubMedGoogle Scholar
  5. Stovner LJ, Hagen K: Prevalence, burden, and cost of headache disorders. Curr Opin Neurol. 2006, 19: 281-285. 10.1097/01.wco.0000227039.16071.92.View ArticlePubMedGoogle Scholar
  6. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, Jarjour I: Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002, 59: 490-498. 10.1212/WNL.59.4.490.View ArticlePubMedGoogle Scholar
  7. Ad Hoc Committee: Linee guida sulla cefaea giovanile. 2003, [http://www.sinpia.eu/atom/allegato/153.pdf]Google Scholar
  8. Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S: American Academy of Neurology Quality Standards Subcommittee; Practice Committee of the Child Neurology Society. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology. 2004, 63: 2215-2224. 10.1212/01.WNL.0000147332.41993.90.View ArticlePubMedGoogle Scholar
  9. Géraud G, Lantéri-Minet M, Lucas C, Valade D: French Society for the Study of Migraine Headache (SFEMC). French guidelines for the diagnosis and management of migraine in adults and children. Clin Ther. 2004, 26: 1305-1318. 10.1016/S0149-2918(04)80161-9.View ArticlePubMedGoogle Scholar
  10. Bendtsen L, Birk S, Kasch H, Aegidius K, Sørensen PS, Thomsen LL, Poulsen L, Rasmussen MJ, Kruuse C, Jensen R: Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 2nd edition. J Headache Pain. 2012, 13 (Suppl 1): S1-S29. 10.1007/s10194-011-0402-9.View ArticlePubMedGoogle Scholar
  11. Guideline Development Group: Headaches: Diagnosis and management of headaches in young people and adults: NICE guidance 2012. NICE guideline. 2012, [http://www.nice.org.uk/Guidance/cg150]Google Scholar

Copyright

© Parisi; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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