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ED treatment of migraine patients has changed

Published:August 20, 2018DOI:https://doi.org/10.1016/j.ajem.2018.08.051

      Abstract

      Study objectives

      Numerous studies have shown benefits of nonnarcotic treatments for emergency department (ED) migraine patients. Our goal was to determine if ED treatment of migraine patients and the rate of return within 72 h have changed.

      Methods

      Design: Multi-hospital retrospective cohort. Population: Consecutive ED patients from 1-1-1999 to 9-31-2014. Protocol: For determining treatments, we examined charts at the beginning (1999–2000) and end (2014) of the time period. We combined similar medications into the following groups: parenteral narcotics, oral narcotics, antihistamines and dopamine receptor antagonists prochlorperazine/metoclopramide (DRA). We calculated the percent of migraine patients given each treatment in each time period. We identified those who returned to the same ED within 72 h, and calculated the difference in annual return rates between 1999–2000 and 2014.

      Results

      Of the 2,824,710 total visits, 8046 (0.28%) were for migraine. We reviewed 290 charts (147 in 1999–2000 and 143 in 2014) to determine migraine treatments. The use of IV fluids, DRA, ketorolac and dexamethasone increased from 1999–2000 to 2014, whereas narcotic use and discharge prescriptions for narcotics decreased. Of the 8046 migraine patients, 624 (8%) returned within 72 h. The return rate decreased from 1999–2000 to 2014 from 12% to 4% (difference = 8%, 95% CI 5%–11%).

      Conclusion

      For ED migraine patients, the use of IV fluids, DRA, ketorolac and dexamethasone increased whereas the use of narcotics and discharge prescriptions for narcotics decreased. The return rates for migraines decreased. We speculate that the increased use of non-narcotic medications contributed to this decrease.

      Keywords

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      References

        • Insinga R.
        • Ng-Mak D.
        • Hanson M.
        Costs associated with outpatient emergency room and inpatient care for migraine in the USA.
        Cephalgia. 2011; 31: 1570-1575
        • Friedman D.
        • Feldon S.
        • Holloway S.
        • et al.
        Utilization, diagnosis, treatment, and cost of migraine treatment in the emergency department.
        Headache. 2009; 49: 1163-1173
        • Morley K.I.
        • Ferris J.A.
        • Winstock A.R.
        • et al.
        Polysubstance use and misuse or abuse of prescription opioid analgesics: a multi-level analysis of international data.
        Pain. 2017; 158: 1138-1144
        • Friedman B.W.
        • West J.
        • Vinson D.R.
        • et al.
        Current management of migraine in the US emergency departments: an analysis of the National Hospital Ambulatory Medical Care Survey.
        Cephalgia. 2015; 35: 301-309
        • Mazer-Amirshahi M.
        • Mullins P.M.
        • Rasooly I.
        • et al.
        Rising opioid prescribing in adult U.S. emergency department visits: 2001–2010.
        Acad Emerg Med. 2014; 21: 236-243
        • Furlan A.D.
        • Sandoval J.A.
        • Mailis-Gagnon A.
        • et al.
        Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects.
        CMAJ. 2006; 174: 1589-1594
        • Lee M.
        • Silverman S.M.
        • Hansen H.
        • et al.
        A comprehensive review of opioid-induced hyperalgesia.
        Pain Physician. 2011; 14: 145-161
        • US Burden of Disease Collaborators
        The state of US health, 1990–2016: burden of diseases, injuries, and risk factors among US states.
        JAMA. 2018; 319: 1444-1472
        • Kane-Gill S.L.
        • Rubin E.C.
        • Smithburger P.L.
        • et al.
        The cost of opioid-related adverse drug events.
        J Pain Palliat Care Pharmacother. 2014; 28: 282-293
        • CDC
        Annual surveillance report of drug-related risks and outcomes—United States, 2017.
        US Department of Health and Human Services, CDC, Atlanta, GA2017
        • Orr S.L.
        • Aubé M.
        • Becker W.J.
        • et al.
        Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings.
        Cephalgia. 2015; 35: 271-284
        • Orr S.L.
        • Friedman B.W.
        • Christie S.
        • et al.
        Management of adults with acute migraine in the emergency department: the American headache society evidence assessment of parenteral pharmacotherapies.
        Headache. 2016; 56: 911-940
        • Katz J.
        • Goodnough A.
        The opioid crisis is getting worse, particularly for black Americans.
        New York Times, December 22, 2017
        • Blendon R.J.
        • Benson J.M.
        The public and the opioid-abuse epidemic.
        N Engl J Med. 2018; 378: 407-411
        • Porter J.
        • Jick H.
        Addiction rare in patients treated with narcotics.
        N Engl J Med. 1980; 302: 123
        • Rudd R.A.
        • Seth P.
        • David F.
        • et al.
        Increases in drug and opioid involved overdose deaths-United States 2010–2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452
        • Hoppe J.A.
        • Kim H.
        • Heard K.
        Association of emergency department opioid initiative with recurrent opioid use.
        Ann Emerg Med. 2015; 65: 493-499
        • Barnett M.L.
        • Olenski A.R.
        • Jena A.B.
        Opioid-prescribing patterns of emergency physicians and risk of long-term use.
        N Engl J Med. 2017; 376: 663-673
        • Jones J.
        • Sklar D.
        • Dougherty J.
        • et al.
        Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache.
        JAMA. 1989; 261: 1174-1176
        • Friedman B.W.
        • Irizarry E.
        • Solorzano C.
        • et al.
        Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine.
        Neurology. 2017; 14: 2075-2082
        • Griffith J.D.
        • Mycyk M.B.
        • Kyriacou D.N.
        Metoclopramide versus hydromorphone for the emergency department treatment of migraine headache.
        J Pain. 2008; 9: 88-94
        • Gilbert E.H.
        • Lowenstein S.R.
        • Koziol-McLain J.
        • et al.
        Chart reviews in emergency research: where are the methods?.
        Ann Emerg Med. 1996; 27: 305-308
        • Bachur R.G.
        • Monuteaux M.C.
        • Neuman M.I.
        A comparison of acute treatment regimens for migraine in the emergency department.
        Pediatrics. 2015; 135: 232-238
        • Lucado J.
        • Paez K.
        • Elixhauser A.
        Headaches in U.S. hospitals and emergency departments, 2008: Statistical brief #111.
        in: Healthcare cost and utilization project (HCUP) statistical briefs. Agency for Healthcare Research and Quality (US), Rockville (MD)2006–2011 ([Internet])