Factors Associated With Emergency Department Visits for Migraine: An Observational Study

Minen, Mia T.; Loder, Elizabeth; Friedman, Benjamin W.

doi:10.1111/head.12461

Cited by 29 publications

(37 citation statements)

References 21 publications

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“…Even if previously diagnosed with migraine, patients who seek acute care in the emergency department may have more severe and prolonged headache attacks, diagnostic uncertainty, and a lack of access to headache care in the outpatient setting. 22 Our patients may have had similar motivations for seeking acute care, and particularly for pregnant patients with headache, our study demonstrates that this is an important issue for resource utilization, as the overwhelming majority of patients were referred for urgent neuroimaging, particularly MRI, as CT is typically avoided because of radiation exposure. 23 In addition, safe treatment of headache during pregnancy is an unmet need by established medical therapies, 24,25 which may also yield a higher rate of presentation to the acute care setting.…”

Section: Discussionmentioning

confidence: 69%

Acute headache diagnosis in pregnant women

et al. 2015

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Objective: To characterize demographic and clinical features in pregnant women presenting with acute headache, and to identify clinical features associated with secondary headache. Methods:We conducted a 5-year, single-center, retrospective study of consecutive pregnant women presenting to acute care with headache receiving neurologic consultation.Results: The 140 women had a mean age of 29 6 6.4 years and often presented in the third trimester (56.4%). Diagnoses were divided into primary (65.0%) and secondary (35.0%) disorders. The most common primary headache disorder was migraine (91.2%) and secondary headache disorders were hypertensive disorders (51.0%). The groups were similar in demographics, gestational ages, and most headache features. In univariate analysis, secondary headaches were associated with a lack of headache history (36.7% vs 13.2%, p 5 0.0012), seizures (12.2% vs 0.0%, p 5 0.0015), elevated blood pressure (55.1% vs 8.8%, p , 0.0001), fever (8.2% vs 0.0%, p 5 0.014), and an abnormal neurologic examination (34.7% vs 16.5%, p 5 0.014). In multivariate logistic regression, elevated blood pressure (odds ratio [OR] 17.0, 95% confidence interval [CI] 4.2-56.0) and a lack of headache history (OR 4.9, 95% CI 1.7-14.5) had an increased association with secondary headache, while psychiatric comorbidity (OR 0.13, 95% CI 0.021-0.78) and phonophobia (OR 0.29, 95% CI 0.09-0.91) had a reduced association with secondary headache.Conclusions: Among pregnant women receiving inpatient neurologic consultation, more than onethird have secondary headache. Diagnostic vigilance should be heightened in the absence of a headache history and if seizures, hypertension, or fever are present. Attack features may not adequately distinguish primary vs secondary disorders, and low thresholds for neuroimaging and monitoring for preeclampsia are justified. Neurology ® 2015;85:1024-1030 GLOSSARY CI 5 confidence interval; HELLP 5 hemolysis, elevated liver enzymes, and low platelet count; ICHD-3 beta 5 International Classification of Headache Disorders, 3rd edition (beta version); OR 5 odds ratio; PRES 5 posterior reversible encephalopathy syndrome.The most common primary headache disorders have a peak prevalence and incidence at a younger age and affect women disproportionately, particularly during childbearing years.1 The female predilection may be explained by the relationship of headache and sex hormones, particularly estrogen.2 Migraine is the most common disabling primary headache disorder, and, in pregnancy, retrospective and prospective studies consistently demonstrate that by the second trimester, migraine frequency typically improves, although attacks of migraine with aura and aura without headache may not reflect this pattern. [3][4][5][6][7][8][9][10] Acute, severe headache in pregnancy is generally regarded as a "red flag" and a cause for further investigation, particularly when new onset. [11][12][13] Various secondary headache disorders are more likely to occur during this time period, 12 possibly related t...

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Section: Discussionmentioning

confidence: 69%

Acute headache diagnosis in pregnant women

et al. 2015

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“…Only 12% (n = 6) of participants stated they bring their patient in most of the time, and only 10% (n = 5) stated they bring their patients in almost all or all of the time. This may explain why, according to one study, the majority of headache patients in the ED were there due to the inability to schedule an appointment as soon as they wanted . Thus, there is likely a group of patients who want expedited medical care even though they might recognize their headache is not an emergency.…”

Section: Discussionmentioning

confidence: 99%

“…This may explain why, according to one study, the majority of headache patients in the ED were there due to the inability to schedule an appointment as soon as they wanted. 1 Thus, there is likely a group of patients who want expedited medical care even though they might recognize their headache is not an emergency. CDC data indicate that approximately 80% of ED visits are due to the wish for expedited care, compared with 66% of visits which are for emergency care.…”

Section: Discussionmentioning

confidence: 99%

“…However, the ED is a suboptimal place for treatment because of the high charges, the long waits for treatment in a bright, noisy environment, and because ED care for migraine is often suboptimal. Only about 20% of patients who go the ED for a migraine are pain‐free when they are discharged and in less than 24 hours, 64% of patients report that their migraines returned . In addition, migraine patients in the ED may receive unnecessary tests (ie, CT scans) and inappropriate first‐line treatment including opioids .…”

Section: Introductionmentioning

confidence: 99%

“…1 Only about 20% of patients who go the ED for a migraine are pain-free when they are discharged and in less than 24 hours, 64% of patients report that their migraines returned. 1 In addition, migraine patients in the ED may receive unnecessary tests (ie, CT scans) and inappropriate first-line treatment including opioids. 2,3 Despite American Headache Society (AHS) guidelines stating that opioids should not be used as first-line treatment for migraine in the ED, 4 opioids are used to treat migraine in more than 50% of ED visits.…”

Section: Introductionmentioning

confidence: 99%

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