Migraine diagnosis and management in general emergency departments in France

Valade, Dominique; Lucas, Christian; Calvel, Laurent; Plaisance, Patrick; Derouet, N.; Meric, G.; Lantéri-Minet, Michel; Giroud, M.

doi:10.1177/0333102410378178

Cited by 22 publications

(43 citation statements)

References 26 publications

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“…For this reason, we were not surprised to find that patients that were admitted to ER were more likely to relapse into CM and to undergo another withdrawal treatment. As showed in previous studies, emergency treatment usually served to treat a severe attack or manage ineffective treatment: the need for ER admission is one of the elements that marks the difference between patients with episodic and chronic migraine and is associated to higher disease cost and burden …”

Section: Discussionmentioning

confidence: 99%

Predictors of 12‐Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study

Raggi¹,

Giovannetti²,

Leonardi³

et al. 2016

Headache

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Predictors or relapse into CM and of occurrence of another withdrawal by 12-months are somehow similar. It is important to assess presence of recent previous withdrawal treatments and to plan regular follow-up afterwards, in particular for patients with high headache frequency and relevant mood disturbances: in this way, it will be more likely that situations requiring further structured withdrawal treatments can be identified before patients have to refer to ER.

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Section: Discussionmentioning

confidence: 99%

Predictors of 12‐Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study

Raggi¹,

Giovannetti²,

Leonardi³

et al. 2016

Headache

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“…A study in 2011 conducted over 22 EDs in France noted that 75% of their ED migraine patients were female, with a mean age of 37.6. [8] A 2006 study on headache in United States EDs also noted that the majority of patients with migraine were females. [9] In Australia 71% of all patients presenting to the EDs with migraine were female, with a median age of 37 years.…”

Section: Prevalence and Impactmentioning

confidence: 99%

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

Shao

Hughes

Eley

2017

World Journal of Emergency Medicine

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BACKGROUND:Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition. METHODS:This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED.RESULTS: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females (71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger (M=37.05, SD=13.23) than the whole ED population (M=46.17 SD=20.50) (P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous (IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates (42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used. CONCLUSION:Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.

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“…Almost half of migraine patients who use the ED have taken no medication before coming to the ED, not even acetaminophen . In France, migraine patients attended the ED for unusually severe attacks (49% of visits) or because of ineffectiveness of their usual treatment (20% of visits) …”

Section: Who Uses the Ed For Management Of Migraine?mentioning

confidence: 99%

“…DHE is used on average in 8% of patients. Patients are also given NSAIDs and other non‐opioid analgesics, though with these treatments, resolution of the headache could take up to 2 days . Interestingly, while antihistamines are not included on the list of recommended medications, diphenhydramine, promethazine, and hydroxyzine are used, on average in 37%, 23%, and 13% of visits, respectively .…”

Section: Concordance Of Ed Treatment For Migraine With Evidencementioning

confidence: 99%

Evaluation and Treatment of Migraine in the Emergency Department: A Review

2014

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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.

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Migraine diagnosis and management in general emergency departments in France

Abstract: Results suggest there is room for improvement in choice of agents prescribed. We propose additional education and training of clinicians to improve adherence to clinical practice guidelines.

Cited by 22 publications

References 26 publications

Predictors of 12‐Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study

Predictors of 12‐Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

Evaluation and Treatment of Migraine in the Emergency Department: A Review

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