Evaluation and Treatment of Migraine in the ED
Head pain is the fifth most common reason for emergency department (ED) visits. It is second only to focal weakness as the most common reason for neurological consultation in the ED. This manuscript reviews how patients with migraine, the most common primary headache disorder for which patients seek medical treatment, are managed in the ED. We discuss existing guidelines for head imaging in patients with migraine, recommended pharmacologic treatments, and current treatment trends. We also review studies evaluating the discharge care of migraine patients in the ED. With the goal of standardizing, streamlining, and optimizing ED-based migraine care, we offer ideas for future research to improve the evaluation, treatment, and discharge care of patients who present to an ED with acute migraine.
Migraine, an episodic headache disorder characterized by acutely disabling attacks, affects 18% of American women and 6% of American men. Migraine is the most common primary headache disorder for which patients seek medical treatment. Migraine causes the majority of the 5 million headache visits to US emergency departments (ED) annually. The mean cost for a migraine-related ED visit in the United States is $775, which translates to a total national annual cost of $700 million. These high costs coupled with the reality of a bright and noisy environment not conducive to migraine treatment suggest that health care systems should try to prevent or divert ED migraine visits. Once a patient presents to an ED for management of migraine, one of the goals of care is to prevent another such visit.
We reviewed the medical literature to (1) identify the characteristics of patients seeking ED care for migraine; (2) examine guidelines and current practice regarding neuroimaging for migraine in the ED; (3) explore the reasons why ED care for migraine deviates from recommended treatment practices, specifically with regard to the use of opioid and migraine specific medications; and (4) investigate potential methods for improving the suboptimal pain and functional outcomes following ED treatment.
Abstract and Introduction
Abstract
Head pain is the fifth most common reason for emergency department (ED) visits. It is second only to focal weakness as the most common reason for neurological consultation in the ED. This manuscript reviews how patients with migraine, the most common primary headache disorder for which patients seek medical treatment, are managed in the ED. We discuss existing guidelines for head imaging in patients with migraine, recommended pharmacologic treatments, and current treatment trends. We also review studies evaluating the discharge care of migraine patients in the ED. With the goal of standardizing, streamlining, and optimizing ED-based migraine care, we offer ideas for future research to improve the evaluation, treatment, and discharge care of patients who present to an ED with acute migraine.
Introduction
Migraine, an episodic headache disorder characterized by acutely disabling attacks, affects 18% of American women and 6% of American men. Migraine is the most common primary headache disorder for which patients seek medical treatment. Migraine causes the majority of the 5 million headache visits to US emergency departments (ED) annually. The mean cost for a migraine-related ED visit in the United States is $775, which translates to a total national annual cost of $700 million. These high costs coupled with the reality of a bright and noisy environment not conducive to migraine treatment suggest that health care systems should try to prevent or divert ED migraine visits. Once a patient presents to an ED for management of migraine, one of the goals of care is to prevent another such visit.
We reviewed the medical literature to (1) identify the characteristics of patients seeking ED care for migraine; (2) examine guidelines and current practice regarding neuroimaging for migraine in the ED; (3) explore the reasons why ED care for migraine deviates from recommended treatment practices, specifically with regard to the use of opioid and migraine specific medications; and (4) investigate potential methods for improving the suboptimal pain and functional outcomes following ED treatment.
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