Use of the Emergency Department for Severe Headache. A Population‐Based Study

Abstract

Background.-Although headache is a common emergency department (ED) chief complaint, the role of the ED in the management of primary headache disorders has rarely been assessed from a population perspective. We determined frequency of ED use and risk factors for use among patients suffering severe headache.Methods.-As part of the American Migraine Prevalence and Prevention study, a validated self-administered questionnaire was mailed to 24,000 severe headache sufferers, who were randomly drawn from a larger sample constructed to be sociodemographically representative of the US population. Participants were asked a series of questions on headache management, healthcare system use, sociodemographic features, and number of ED visits for management of headache in the previous 12 months. In keeping with the work of others, "frequent" ED use was defined as a particpant's report of 4 or more visits to the ED for treatment of a headache in the previous 12 months. Headaches were categorized into specific diagnoses using a validated methodology.Results.

Headache in the emergency room: the role of immigrant background on the frequency of serious causes and diagnostic procedures

“…In particular, a low socioeconomic status, frequently encountered in immigrants, may partially explain a higher rate of headache as chief complaint [29]. Low socioeconomic status may also be associated with a higher prevalence of recurrent headache and has been shown to increase the probability of a headache patient to present to the ER [30][31][32]. A low socioeconomic status is also a property of the population (of immigrant and non-immigrant background) in the district Berlin-Wedding, in which our hospital is located.…”

Health Information Exchange Improves Identification Of Frequent Emergency Department Users

“…7 Compared with other ED users, frequent users have more social, psychiatric, and substance abuse issues [8][9][10][11][12][13][14][15][16] and tend to be sicker, with medical conditions that are both more complex and more acute. [17][18][19][20][21][22] In addition, frequent users are more frequently admitted to the hospital, 15 incur higher costs, 23,24 and have higher mortality rates. 25,26 Studies have dispelled the common myth that frequent users are typically uninsured, showing that instead they are more often underinsured participants in government programs such as Medicaid.…”

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

“…Their effi cacy is no better than NSAID use, while having more side effects and a higher migraine recurrence rate. [20] Opioid use should only be considered as a last resort when other options are contraindicated or have failed.…”

“…This is also prevalent in the United States, where opioids are the most commonly prescribed medication for treating migraine in EDs. [20] Criticisms for opioid use in migraine patients include low effi cacy, increased recurrence, and high rates of adverse effects. [16] Opioids are commonly given for other acute pain conditions as they are generally safe and well-tolerated.…”