Danielle J. Kellier

Headache evaluation and treatment are believed to be influenced by race and ethnicity. Specific headache diagnosis assigned in the pediatric emergency department (ED) may compound disparities. We sought to investigate racial and ethnic disparities in the diagnosis, testing, and treatment of pediatric patients with headache presenting to the ED. We performed a cross-sectional analysis of ED visits from 49 children's hospitals between 2016 and 2022 from the Pediatric Health Information System, an administrative database of ED and hospitalized encounters within children's hospitals in the United States. Index encounters in the ED from patients (aged 5-21 years, median age 13 [10-15]) with a primary diagnosis of migraine, headache, new daily persistent headache, or tension-type headache were included. Encounters with trauma, infection, and malignancy where secondary headache was possible were excluded. The primary outcomes were the rates of migraine diagnosis, testing, and treatment. We used generalized estimating equations to estimate associations between race and ethnicity and outcomes after adjusting for demographic factors, medical complexity, visit timing, and final headache diagnosis. A total of 309,678 encounters were included while 61,677 repeat visits, 81,821 visits with diagnoses suggestive of secondary headache, and 5,714 visits from 3 hospitals with sparse data on patient race/ethnicity were excluded. Of 160,466 eligible visits (59.8% female), 41% were by non-Hispanic White (NHW) children, 24.8% non-Hispanic Black (NHB), and 26.0% Hispanic/Latino (HL). NHW children were more frequently diagnosed with migraine (45.5% vs NHB 28.2% and HL 28.3%, p < 0.001). NHB and HL children compared with NHW children received less testing including brain MRI scans (adjusted odds ratio [aOR]: NHB 0.56 [95% CI 0.46-0.69] and HL 0.54 [0.36-0.82]). There was no difference in the proportion of visits without administration of headache-related medications (NHW 23.3% vs NHB 24.6% and HL 23.4%, p = 0.64). NHB and HL children were more likely to receive only oral medications (aOR: NHB 1.37 [1.2-1.56] and HL 1.54 [1.34-1.76]) and less likely to be admitted inpatient (aOR: NHB 0.8 [0.66-0.97] and HL 0.65 [0.44-0.94]). NHB and HL children in the pediatric ED with headache receive fewer migraine diagnoses, less testing, and less intensive treatment compared with NHW children. Beyond affecting headache management, this inequity in migraine diagnosis requires further consideration to include children from marginalized racial and ethnic groups in future migraine research.

Test‐retest reliability—establishing that measurements remain consistent across multiple testing sessions—is critical to measuring, understanding, and predicting individual differences in infant language development. However, previous attempts to establish measurement reliability in infant speech perception tasks are limited, and reliability of frequently used infant measures is largely unknown. The current study investigated the test‐retest reliability of infants’ preference for infant‐directed speech over adult‐directed speech in a large sample (N = 158) in the context of the ManyBabies1 collaborative research project. Labs were asked to bring in participating infants for a second appointment retesting infants on their preference for infant‐directed speech. This approach allowed us to estimate test‐retest reliability across three different methods used to investigate preferential listening in infancy: the head‐turn preference procedure, central fixation, and eye‐tracking. Overall, we found no consistent evidence of test‐retest reliability in measures of infants’ speech preference (overall r = 0.09, 95% CI [−0.06,0.25]). While increasing the number of trials that infants needed to contribute for inclusion in the analysis revealed a numeric growth in test‐retest reliability, it also considerably reduced the study's effective sample size. Therefore, future research on infant development should take into account that not all experimental measures may be appropriate for assessing individual differences between infants.Research Highlights: We assessed test‐retest reliability of infants’ preference for infant‐directed over adult‐directed speech in a large pre‐registered sample (N = 158). There was no consistent evidence of test‐retest reliability in measures of infants’ speech preference. Applying stricter criteria for the inclusion of participants may lead to higher test‐retest reliability, but at the cost of substantial decreases in sample size. Developmental research relying on stable individual differences should consider the underlying reliability of its measures.

Objective: To assess agreement for migraine day between self‐report and diagnostic guidelines for children and adolescents using a headache diary. Background: Trial guidelines recommend prospective collection of headache features and adoption of migraine day as an outcome measure, but there is no clear consensus on the definition of migraine day. Methods: This is a secondary analysis of data from two projects—a prospective cohort study validating a pediatric scale of treatment expectancy and a clinical trial of occipital nerve blocks to treat status migrainosus. Participants completed a text message‐based diary for 4 or 12 weeks (depending on treatment), and a detailed headache assessment on a random 20% of headache days. Using this assessment, we determined whether a headache day qualified for migraine or probable migraine, based on the International Classification of Headache Disorders, 3rd edition (ICHD‐3). Results: Of 122 enrolled children and adolescents, 106 (86.9%) completed ≥1 detailed headache assessment (438 entries). We found moderate agreement between self‐reported and ICHD‐derived migraine day, with a Cohen's Kappa of 0.50 (positive predictive value [PPV]: 0.66; negative predictive value [NPV]: 0.85; correlation: 0.51). Allowing for ICHD‐derived probable migraine significantly increased PPV (0.66 vs. 0.94; 95% CI: 0.57–0.74 vs. 0.90–0.97), but decreased NPV (0.85 vs. 0.293; CI: 0.77–0.90 vs. 0.199–0.40), Cohen's Kappa (0.50 vs. 0.237; CI: 0. 389–0.60 vs. 0.139–0.352), and correlation ( r = 0.51 vs. 0.302; CI: 0.41–0.61 vs. 0.192–0.41). Pain severity (OR: 5.7; CI: 2.39–13.8), photophobia (OR: 4.1; CI: 1.02–16.6), and phonophobia (OR: 7.5; CI: 1.95–29.3) were significantly associated with participants' perception of migraine. Conclusion: We found only moderate agreement between self‐reported and ICHD‐derived migraine day, suggesting both measures are not equal but may represent overlapping aspects of migraine as a disease. This highlights the difficulty of applying ICHD criteria to individual attacks. We recommend greater methodological transparency in future research to avoid readers conflating both measures.

Background: International guidelines recommend diaries in migraine trials for prospective collection of headache symptoms. Studies in other patient populations suggest higher adherence with electronic diaries instead of pen-and-paper. This study examines the feasibility of a text message-based (texting) diary for children and adolescents with headache. Methods: This is a secondary analysis of data from a study validating a pediatric scale of treatment expectancy. We developed a Health Insurance Portability and Accountability Act-compliant texting diary collecting headache characteristics, medication use, and disability with 3–5 core daily questions for 4 or 12 weeks depending on headache treatment. Adherence was incentivized. Results: 93 participants consented to the expectancy study. Five participants opted for a paper diary for follow-up. 88 participants chose the texting diary with 28 4-week and 60 12-week participants. Five participants did not complete the enrollment visit. Of those remaining 83, 89% of 4-week and 93% of 12-week participants responded on at least 80% of days. On average, participants fully completed 88% (4-week cohort) and 90% (12-week) of diary entries. Conclusions: Text messages are a promising method for collecting patient-reported data. Adherence was similar to that reported for paper diaries in other pediatric migraine trials, but time-stamped entries ensure real-time data collection.