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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Article Info
Publication History
Published online: August 20, 2018
Accepted:
August 20,
2018
Received in revised form:
July 29,
2018
Received:
June 13,
2018
Footnotes
☆Presentations: Ruzek MA, Richman P, Eskin B, Allegra JR. Emergency Department Treatment of Migraines Has Changed Significantly Since 1999–2000. (abstract) Academic Emerg Med. May 2017, Volume 24, Supplement 1, Page S194.
☆Ruzek M, Dewey K, Allegra JR, Eskin B, Richman P. Temporal Trends in Emergency Department Revisit Rates for Migraines. (abstract) Academic Emerg Med. May 2015, Volume 22, Supplement 1 Page S51.
Identification
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