We opened a Headache Infusion Center (HIC) in June 2017 with the goal of reducing emergency room (ER) visits and cost of care.

Headache has been shown to be the third leading chief complaint in Emergency Department visits. It causes a significant burden on the life of the child and caregiver with a higher rate of hospital admissions, higher percentage of ER visits than the general population, and a significant barrier to school progress and performance.

Data was collected prospectively on medications used, efficacy of medications, admission rate, pain scores, ER visits for a year prior to and after the visit to the HIC. We collected information on demographics, medications, duration of diagnosis and billing information. Patients received the first pathway consisting of an intravenous fluid bolus, ketorolac, prochlorperazine and diphenhydramine. If no relief, the second pathway of a dose of intravenous valproate sodium was administered after which they were admitted if the headache persisted.

297 total patients were seen from June 7, 2017 – June 30, 2019 in the HIC. 89% were Caucasian, 7.1 % were black, and 4.0% were other races. 78% were female and 21.9% were male with a mean age 15 years. 39% patients needed the second pathway. Pain score (scale of 0-10) was a mean of 6.7 pre infusion compared to 1.3 post infusion (p<0.001).The number of ED visits reduced from a mean of 1.1 visits in the year before the visit to the HIC to 0. 6 in the year after the visit to the HIC (p< 0.001). Lastly, private payor bills  decreased by 50% from $3727 for an ER visit to $1842 for an HIC visit.

Pediatric headache infusion centers can be an effective way to decrease ED visits and cost of care for children with headaches.