Do Pain Scores Correlate With Vital Signs in Pediatric Patients With Migraine Headaches?

BACKGROUND: Pain assessment in children is challenging, and clinicians often rely on changes in vital signs (VS) as surrogate markers of pain intensity. Although acute pain typically provokes predictable autonomic responses, chronic or acute-on-chronic pain states such as migraine may not elicit these changes consistently. OBJECTIVE: We sought to determine whether changes in self-reported pain scores are associated with concurrent changes in heart rate (HR), systolic blood pressure (SBP), or diastolic blood pressure (DBP) among children hospitalized for migraine. We hypothesized that pain intensity would not significantly correlate with these VS. METHODS: We conducted a retrospective cohort study of patients aged 7 to 18 years admitted with a primary diagnosis of migraine between 2010 and 2018. Self-reported pain scores were paired with HR, SBP, and DBP that were recorded within 1 hour. Patients were excluded if no contemporaneous VS were available or if medical record review revealed miscoded diagnoses. Analyses were performed for the overall cohort and stratified by age (7-11 and 12-18 years). RESULTS: Of 1335 patients identified, 100 were excluded for miscoded diagnoses and 458 were excluded for missing vital sign data. Among 777 patients included, no significant associations were observed between pain scores and HR, SBP, or DBP in the overall cohort or in any stratified age group. CONCLUSION: In children hospitalized for migraine, vital sign changes did not correlate with self-reported pain scores. These findings indicate that VS are unreliable indicators of self-reported pain severity and underscore the importance of multimodal, patient-centered pain assessment strategies.