588 - Trends in Gabapentin Use Among Hospitalized Pediatric Patients With Migraine Headache: A Retrospective Review

Publication Number: 3569.588

Jean Bernard Salloum, Midwestern University, Glendale, AZ, United States; Andrew Ritchey, Phoenix Children's Hospital, Phoenix, AZ, United States; Maheshwor Kafle, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Migraine is one of the most common neurologic causes of hospitalization in children and adolescents. Gabapentin, an anticonvulsant with neuromodulator properties, is sometimes used off label for migraine management; however, evidence supporting its efficacy in pediatric migraine is limited. Systematic reviews have shown no significant benefit over placebo for prophylaxis, and its role in acute treatment remains unclear. Despite this, recent meta-analyses indicate that off-label medications-gabapentin-may be prescribed 1.5 times more often than FDA-approved agents for migraine (1). Understanding real-world prescribing trends is essential to identify opportunities for stewardship, reduce unnecessary exposure to ineffective medications, and guide trials aimed at improving evidence-based care.

Objective: To evaluate inpatient prescribing patterns of Gabapentin for pediatric patients hospitalized with migraine and associated readmission rates.

Design/Methods: An IRB approved retrospective study was conducted for patients admitted with a diagnosis of migraine headache between 2019 and 2024 at a tertiary children's hospital. Data were extracted from the medical record, including diagnoses, medication use, and demographics. Gabapentin exposure during hospitalization was used to define treatment groups. Annual prescribing trends were analyzed using the Cochran-Armitage test for trend; group comparisons were performed using chi-square testing, with statistical significance defined as p < 0.05. Readmission rates were compared between treatment groups.

Results: A total of 2,029 patients met inclusion criteria; 291 (14.3%) received gabapentin and 1,738 (85.7%) did not. Yearly use ranged from 12.2% in 2019 to 13.4% in 2024, with no significant temporal trend (slope estimate = 0.0050; 95% CI -0.0018 to 0.0118; p = 0.43) (Figure 1). Readmission rates were higher among patients prescribed gabapentin compared with those who were not: within 7 days, 4.5% vs 3.2% (p = 0.29); 8-30 days, 7.6% vs 7.0% (p = 0.71); >30 days, 33.0% vs 23.8% (p = 0.0013); and any time, 45.0% vs 34.0% (p = 0.0003) (Figure 2).

Conclusion(s): Despite limited supporting evidence, Gabapentin continues to be prescribed in approximately one in eight pediatric migraine admissions, with stable utilization over six years. Gabapentin use was not associated with reduced readmissions and may be linked to higher rates, suggesting a potential gap between practice and evidence. These findings underscore the need for ongoing prescribing stewardship and prospective research to define an evidence-based role of Gabapentin for pediatric migraine management.

Annual Inpatient Gabapentin Use for Pediatric Migraine
Figure 1. Temporal trend in inpatient gabapentin prescribing for pediatric migraine, 2019-2024. Percentile represents the proportion of migraine admissions treated with gabapentin each year.

Percent of Patients Readmitted With Migraine
Figure 2. Percent of pediatric migraine patients readmitted after hospitalization, stratified by time since discharge ( <7 days, 8-30 days, >30 days, and all-time readmissions).