American Headache Society Survey About Urgent and Emergency Management of Headache Patients

Minen, Mia T.; Ortega, Emma; Lipton, Richard B.; Cowan, Robert P.

doi:10.1111/head.13387

Cited by 8 publications

(9 citation statements)

References 13 publications

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“…The treatment provided was adequate for the majority of consultations. There was excessive use of opioids, contrary to the recommendations of the Brazilian Headache Society and the International Headache Society 2,8 . However, similar conduct, and with even higher rates of opioid use, is also found in the American population, where a substantial proportion of headache specialists are dissatisfied with the treatment offered by emergency services 8 .…”

Section: Discussionmentioning

confidence: 65%

“…The medication most commonly administered was dipyrone, followed by antiemetics and corticosteroids. Despite the recommendations of the Brazilian Headache Society and the International Headache Society 2,8 , which advise against use of opioids for migraine, these drugs were used for 30.2% of the individuals diagnosed. Moreover, those who received opioids were twice as likely to experience migraine.…”

Section: Discussionmentioning

confidence: 99%

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Impact of headache on a supplemental healthcare emergency unit and on use of opioids

Silva

Kiy

Alves

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: Headache is one of the most common causes of emergency care and migraines are the most common primary headache in this regard. Objective: The aim of this research study was to assess the incidence of medical consultations due to headache, along with demographic characteristics and treatments pertaining to cephalalgia that were offered to patients cared for in supplemental healthcare emergency rooms. Methods: In 2017, a total of 11,105 consultations took place, and 4,865 (43.8%) of them were complaints relating to headache. 407 records of patients with headache were randomly selected and assessed. Demographic, clinical and therapeutic data were collected using a structured form. Results: The cause of headache was diagnosed as migraine in 60.0% of the patient records. Patients were mostly female (75.2%), with an average age of 33.9 ± 13.7 years. Patient management consisted of administering dipyrone in 62.4% of cases, antiemetics in 66.9%, corticosteroids in 58.9%, opioids in 24.3% and NSAIDs in 13.5%. Use of opioids was associated with a diagnosis of migraine (OR 2.4; CI 1.4-3.9; p = 0.001). Patients who received opioids were kept under observation for longer periods of time (OR 3.4; CI 2.1-5.4; p < 0.001) and exhibited a higher rate of use of antiemetics (OR 11.0; CI 4.7-25.9; p < 0.001), compared with patients who did not receive opioids. Conclusion: Dipyrone and antiemetics were administered to most of the patients. Opioids were used for a significant proportion of these individuals, despite the diagnosis of migraine, a condition for which their use is discouraged.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Impact of headache on a supplemental healthcare emergency unit and on use of opioids

Silva

Kiy

Alves

et al. 2021

Arq. Neuro-Psiquiatr.

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“…As mentioned above, to improve the standardization of migraine care, perhaps urgent care providers could use the MAP or a modified version . Prior research has already shown the need for better communication and consistency between headache specialists/neurologists and acute care physicians for the optimization of acute migraine treatment . We suggest that a system can be developed to ensure adequate follow‐up of urgent care visits.…”

Section: Discussionmentioning

confidence: 99%

“…21 Prior research has already shown the need for better communication and consistency between headache specialists/neurologists and acute care physicians for the optimization of acute migraine treatment. 22 We suggest that a system can be developed to ensure adequate follow-up of urgent care visits.…”

Section: Discussionmentioning

confidence: 99%

A Brief Look at Urgent Care Visits for Migraine: The Care Received and Ideas to Guide Migraine Care in this Proliferating Medical Setting

2019

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Objective There has been a rise in urgent care centers throughout the country over the past 10 years, leading to an increase in patients accessing medical care in these locations. These centers advertise an alternative to the Emergency Department (ED) for the evaluation and treatment of urgent medical conditions. The goal of this analysis was to examine the use of urgent care visits for migraine within 2 urgent care centers within a large academic medical system in New York City. We examined the trends in management and treatment of migraine in these urgent care settings, as well as prescriptions and instructions given to this patient population upon discharge. We paid particular attention to whether the medications administered and prescribed on discharge were those recommended by American Headache Society migraine management guidelines. Methods We conducted a retrospective chart review of patients with migraine diagnoses at 2 different urgent care locations within 1 large urban medical center. We determined baseline patient demographics, previous migraine characteristics, frequencies of reasons for urgent care visits as well as various medications administered, medications prescribed on discharge, and characteristics of patient outcomes post‐discharge. Results Of the 78 patients who visited urgent care with a migraine diagnosis, 20 (25.6%) had a known primary care provider within the urgent care centers' healthcare system. More than three‐fourths of all patients (78.2%) had a self‐reported history of either recurrent headache or migraine prior to the urgent care visit. Of those with a documented frequency of prior headaches, 94.1% (32/34) had episodic migraine and 79.4% (27/34) experienced at most 1‐2 headache days per month. Of those presenting to the urgent care during an episode of migraine, 12.3% (9/73) were given intravenous metoclopramide and none were given subcutaneous sumatriptan or intravenous prochlorperazine. Of those with reported nausea or vomiting with their migraine, 46.2% (18/39) received an anti‐emetic at the visit and 33.3% (13/39) were given an anti‐emetic prescription. Only 11.1% (6/54) of patients who did not have a record of previous triptan use were given a triptan prescription at the urgent care visit. Conclusions The majority of patients in our study who sought medical treatment for migraine in these 2 urgent care centers were not established patients within the urgent care centers' healthcare system. While 93.6% (73/78) of patients were experiencing current pain upon presentation to the urgent care centers, only 12.3% (9/73) received administration of the medications with the highest level of evidence by the American Headache Society (Level B) for acute migraine treatment in an ED. In addition, the majority of patients with a migraine history presenting to the urgent care setting were not given triptans or anti‐emetic prescriptions upon discharge from their urgent care visit. Having these migraine‐specific prescriptions may improve self‐treatment at home should a migraine attack recur.

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“…The most common headache disorders are migraine, tension-type headache (TTH) and trigeminal autonomic cephalalgias (TACs). Moreover, in many recent studies, headache is reported as one of the most frequent admitting symptoms to the emergency department, even if it has been well stated that the ED is a suboptimal place for headache treatment, suggesting that an urgent admission to a headache centre should be preferred even in the acute headache attacks [1].…”

mentioning

confidence: 99%

Headache relevance in outpatient activity during Covid-19 pandemic

Gatti¹,

Manneschi²

2020

Neurol Sci

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American Headache Society Survey About Urgent and Emergency Management of Headache Patients

Cited by 8 publications

References 13 publications

Impact of headache on a supplemental healthcare emergency unit and on use of opioids

Impact of headache on a supplemental healthcare emergency unit and on use of opioids

A Brief Look at Urgent Care Visits for Migraine: The Care Received and Ideas to Guide Migraine Care in this Proliferating Medical Setting

Headache relevance in outpatient activity during Covid-19 pandemic

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