To describe our experience creating a pediatric headache infusion center to be used as a model for other institutions as well as describe the positive economic impact this has.

Headache is a common cause of pain and disability in children and adolescents. This patient population frequently seeks headache treatment in the emergency department and inpatient setting, both of which are costly and lead to inefficient use of potentially scarce resources. Because of this, intensive outpatient treatment of headache at infusion centers has been proposed as a potential alternative. However, there is a paucity of literature regarding the process of developing such headache infusion centers as well as a paucity of literature comparing the costs of outpatient infusion centers for pediatric headache treatment to the costs of emergency department visits or inpatient admissions for pediatric headache.

Emergency department and inpatient neurology admissions for headache management at Boston Children's Hospital were identified through BCH360, the hospital’s business intelligence system through the MicroStrategy platform that pulls information from the hospital’s data warehouse. For the relevant encounters, cost per encounter information was pulled from the hospital’s Strata database.

In our center, we found that the average cost of an outpatient infusion center visit, emergency department visit, and inpatient admission for headache without dihydroergotamine administration were $1,080 (n=3), $1,451 (n=168), and $7,595 (n=15), respectively. The average cost for headache treatment with dihydroergotamine administration in the outpatient infusion center was $6,318 (n=5) versus $9,995 (n=15) in the inpatient setting. We do not give dihydroergotamine treatment in the emergency department at our institution, thus these data are not included.

The economic impact of pediatric headache on direct health care costs is exceptionally high. This study demonstrates that developing pediatric headache infusion centers can help to decrease the economic burden of pediatric headache.