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

Abstract

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.

Overuse of opioids for acute migraine in an Australian emergency department

“…Our study period of 5 years, in addition to two previous 12‐month and one 3 year study, strengthens our understanding of ED prescribing patterns over time. Our findings add to the existing international literature regarding the need for improvement in acute migraine management in EDs worldwide, with similarities in findings suggesting that a common approach to improvement strategies may be possible.…”

“…Two studies, almost a decade apart, found that there was wide heterogeneity in prescriptions for acute migraine, with low rates of triptan use and common opioid prescription . This finding was confirmed in a more recent Australian study which investigated prescription differences between first and repeat presentations to ED with migraine; it concluded that first time presentations are investigated more heavily but did not receive any significantly different prescriptions …”

An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review

“…This included: 57% ( n = 8) from the United States, 21% ( n = three) from Australia and 7% ( n = one) from Pakistan, France, and Canada. The study population with migraine ranged between 78 [ 18 ] and 2228 [ 1 ] subjects. Most migraineurs presenting to ED were young and female with average age ranges between 32.5 [ 18 ] and 44.5 [ 19 ] years and females consisting between 64% [ 27 ] and 85.9% of patients [ 19 ].…”

“…Migraine headache is a common, debilitating, and costly neurological disorder, affects up to 16.6% of the general population [ 1 ] and is recognized as the second most disabling condition in the world according to disability adjusted life years [ 2 ]. Beyond individual wellbeing and suffering, migraine is a public health issue that puts a burden on society through healthcare system and productivity costs.…”

The Role of Genetic Polymorphisms in Chronic Pain Patients

“…In addition, ESR1 rs1801132 (325C>G) is positively associated with migraine in a Spanish population. ESR1 rs2228480 (594G>A) carries a higher risk for migraine in an Australian population, whereas ESR1 rs2234693 is associated with migraine susceptibility in a Chinese population [ 23 ]. The neuronal etiology of migraine is described by increased ascending signaling and diminished descending inhibitory signals [ 24 ].…”