1887
Volume 2016, Issue 3
  • ISSN: 1999-7086
  • E-ISSN: 1999-7094

Abstract

Migraines are one of the commonest presenting complaints to emergency departments (ED), and may result in prolonged length of stay with symptoms being severe and refractory to typical remedies, such as paracetamol, non-steroidal anti-inflammatory drugs and triptans. The objective of this study was to describe and compare patient demographics, presentation, management and outcomes to hospital discharge between first presenters and patients with a history of migraines in two metropolitan emergency departments in Melbourne, Australia. Given that the assessment and management of patients who have had a prior history of migraines is likely to be substantially different, patients were subgrouped by this exposure variable. A total of 365 patients were identified retrospectively during the study period of March 2013 – September 2014 that met the inclusion criteria of a headache with no organic cause and/or symptoms consistent with visual or abdominal migraines. Presenting pain scores, assessment, management and disposition were extracted using explicit chart review. The mean age of patients included was 37.8 years and 23.3% were males. Significantly more first presenters were investigated with a CT scan of the brain (34.4% as compared to 22.9% of patients with a prior history of migraine).

Initial management included administration of paracetamol in 178 (48.8%) cases, NSAIDs (mostly ibuprofen and aspirin) in 187 (51.2%) and parenteral dopamine antagonists (e.g. metoclopramide, prochlorperazine and chlorpromazine) in 191 (52.3%) cases. Migraine-specific agents such as triptans were prescribed in 46 (12.6%) and ergots in two (0.5%) cases. Opioids such as morphine or oxycodone were administered in 94 (25.8%) cases. There was no statistical difference in the management of patients with a history of migraines as compared to first presenters, with the exception of the use of intravenous fluids and parenteral dopamine antagonists. The median length of stay in the ED was 4 (inter-quartile range 2–7) hours, with 163 (44.7%) patients admitted to the short-stay unit. A pain score of ≥ 5 was recorded at discharge in 31 (8.5%) patients. Disposition was similar across both groups of patients. Although first presenters seem to be more thoroughly investigated, the acute management of migraine did not differ largely between patients who had a history of migraine compared with first presenters. The management of acute migraine in the ED setting has varied efficacy, suggesting that further research into newer therapeutic options is needed.

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2016-11-14
2019-08-20
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References

  1. [1]. Evans   RW., , Friedman   BW. . Headache in the emergency department. . Headache . 2011; ;51: 8 : 1276– 1278 .
    [Google Scholar]
  2. [2]. Friedman   BW., , Hochberg   ML., , Esses   D., , Grosberg   B., , Corbo   J., , Toosi   B., , Meyer   RH., , Bijur   PE., , Lipton   RB., , Gallagher   EJ. . Applying the International Classification of Headache Disorders to the emergency department: An assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. . Ann Emerg Med.   2007; ;49: 4 : 409– 419 , 19. e1–e9 .
    [Google Scholar]
  3. [3]. Sahai-Srivastava   S., , Desai   P., , Zheng   L. . Analysis of headache management in a busy emergency room in the United States. . Headache . 2008; ;48: 6 : 931– 938 .
    [Google Scholar]
  4. [4]. Gelfand   AA., , Goadsby   PJ. . A Neurologist's guide to acute migraine therapy in the emergency room. . Neurohospitalist . 2012; ;2: 2 : 51– 59 .
    [Google Scholar]
  5. [5]. Goadsby   PJ., , Zanchin   G., , Geraud   G., , de Klippel   N., , Diaz-Insa   S., , Gobel   H., , Cunha   L., , Ivanoff   N., , Falques   M., , Fortea   J. . Early vs. non-early intervention in acute migraine-’Act when Mild (AwM)’. A double-blind, placebo-controlled trial of almotriptan. . Cephalalgia . 2008; ;28: 4 : 383– 391 .
    [Google Scholar]
  6. [6]. Beran   R. . Management of chronic headache. . Aust Fam Physician . 2014; ;43: : 106– 110 .
    [Google Scholar]
  7. [7]. Kelly   AM., , Walcynski   T., , Gunn   B. . The relative efficacy of phenothiazines for the treatment of acute migraine: A meta-analysis. . Headache . 2009; ;49: 9 : 1324– 1332 .
    [Google Scholar]
  8. [8]. Saguil   A., , Lax   JW. . Acute migraine treatment in emergency settings. . Am Fam Physician . 2014; ;89: 9 : 742– 744 .
    [Google Scholar]
  9. [9]. Kelly   AM. . Migraine: Pharmacotherapy in the emergency department. . West J Med . 2000; ;173: 3 : 189– 193 .
    [Google Scholar]
  10. [10]. Logan   P., , Lewis   D. . Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. Chlorpromazine in migraine. . EMJ . 2007; ;24: 4 : 297– 300 .
    [Google Scholar]
  11. [11]. Stark   RJ., , Stark   CD. . Migraine prophylaxis. . Med J Aust . 2008; ;189: 5 : 283– 288 .
    [Google Scholar]
  12. [12]. Vos   T., , Flaxman   AD., , Naghavi   M., , Lozano   R., , Michaud   C., , Ezzati   M. , et al.   Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. . Lancet . 2012; ;380: 9859 : 2163– 2196 .
    [Google Scholar]
  13. [13]. Steiner   TJ., , Stovner   LJ., , Birbeck   GL. . Migraine: The seventh disabler. . Headache . 2013; ;53: 2 : 227– 229 .
    [Google Scholar]
  14. [14]. Sanderson   JC., , Devine   EB., , Lipton   RB., , Bloudek   LM., , Varon   SF., , Blumenfeld   AM., , Goadsby   PJ., , Buse   DC., , Sullivan   SD. . Headache-related health resource utilisation in chronic and episodic migraine across six countries. . J Neurol Neurosurg Psychiatry . 2013; ;84: 12 : 1309– 1317 .
    [Google Scholar]
  15. [15]. Wober-Bingol   C., , Wober   C., , Uluduz   D., , Uygunolu   U., , Aslan   TS., , Kernmayer   M., , Zesch   HE., , Gerges   NT., , Wagner   G., , Siva   A., , Steiner   TJ. . The global burden of headache in children and adolescents – developing a questionnaire and methodology for a global study. . Headache Pain . 2014; ;15: : 86 .
    [Google Scholar]
  16. [16]. Steiner   TJ., , Scher   AI., , Stewart   WF., , Kolodner   K., , Liberman   J., , Lipton   RB. . The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. . Cephalalgia . 2003; ;23: 7 : 519– 527 .
    [Google Scholar]
  17. [17]. Kelly   AM., , Knott   J., , Bennetts   S., , Huckson   S., , National Institute for Clinical Studies National Emergency Care Pain Management Project. . Treatment of migraine in Australian Emergency Departments. . EMA . 2009; ;21: 4 : 333– 334 .
    [Google Scholar]
  18. [18]. Detsky   ME., , McDonald   DR., , Baerlocher   MO., , Tomlinson   GA., , McCrory   DC., , Booth   CM. . Does this patient with headache have a migraine or need neuroimaging?.   JAMA . 2006; ;296: 10 : 1274– 1283 .
    [Google Scholar]
  19. [19]. Martin   VT., , Penzien   DB., , Houle   TT., , Andrew   ME., , Lofland   KR. . The predictive value of abbreviated migraine diagnostic criteria. . Headache . 2005; ;45: 9 : 1102– 1112 .
    [Google Scholar]
  20. [20]. Kelley   NE., , Tepper   DE. . Rescue therapy for acute migraine, part 2: Neuroleptics, antihistamines, and others. . Headache . 2012; ;52: 2 : 292– 306 .
    [Google Scholar]
  21. [21]. Krymchantowski   AV., , Barbosa   JS. . Prednisone as initial treatment of analgesic-induced daily headache. . Cephalalgia . 2000; ;20: 2 : 107– 113 .
    [Google Scholar]
  22. [22]. Boe   MG., , Mygland   A., , Salvesen   R. . Prednisolone does not reduce withdrawal headache: A randomized, double-blind study. . Neurology . 2007; ;69: 1 : 26– 31 .
    [Google Scholar]
  23. [23]. Kelly   AM., , Kerr   D., , Clooney   M. . Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: A randomised controlled trial. . EMJ . 2008; ;25: 1 : 26– 29 .
    [Google Scholar]
  24. [24]. Inan   LE., , Inan   N., , Karadas   O., , Gül   HL., , Erdemolu   AK., , Türkel   Y., , Akyol   A. . Greater occipital nerve blockade for the treatment of chronic migraine: A randomized, multicenter, double-blind, and placebo-controlled study. . Acta Neurol Scand . 2015; ;132: 4 : 270– 277 .
    [Google Scholar]
  25. [25]. Williams   DR., , Stark   RJ. . Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. . Cephalalgia . 2003; ;23: 10 : 963– 971 .
    [Google Scholar]
  26. [26]. Connor   KM., , Shapiro   RE., , Diener   HC., , Lucas   S., , Kost   J., , Fan   X., , Fei   K., , Assaid   C., , Lines   C., , Ho   TW. . Randomized, controlled trial of telcagepant for the acute treatment of migraine. . Neurology . 2009; ;73: 12 : 970– 977 .
    [Google Scholar]
  27. [27]. Lipton   RB., , Dodick   DW., , Silberstein   SD., , Saper   JR., , Aurora   SK., , Pearlman   SH., , Fischell   RE., , Ruppel   PL., , Goadsby   PJ. . Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: A randomised, double-blind, parallel-group, sham-controlled trial. . Lancet Neurol.   2010; ;9: 4 : 373– 380 .
    [Google Scholar]
  28. [28]. Bhola   R., , Kinsella   E., , Giffin   N., , Lipscombe   S., , Ahmed   F., , Weatherall   M., , Goadsby   PJ. . Single-pulse transcranial magnetic stimulation (sTMS) for the acute treatment of migraine: Evaluation of outcome data for the UK post market pilot program. . Headache Pain . 2015; ;16: : 535 .
    [Google Scholar]
  29. [29]. Linde   K., , Streng   A., , Jurgens   S., , Hoppe   A., , Brinkhaus   B., , Witt   C., , Wagenpfeil   S., , Pfaffenrath   V., , Hammes   MG., , Weidenhammer   W., , Willich   SN., , Melchart   D. . Acupuncture for patients with migraine: A randomized controlled trial. . JAMA . 2005; ;293: 17 : 2118– 2125 .
    [Google Scholar]
  30. [30]. Cohen   M., , Parker   S., , Taylor   D., , Smit de   V., , Ben-Meir   M., , Cameron   P., , Xue   C. . Acupuncture as analgesia for low back pain, ankle sprain and migraine in emergency departments: Study protocol for a randomized controlled trial. . Trials . 2011; ;12: : 241 .
    [Google Scholar]
  31. [31]. Oberg   EB., , Rempe   M., , Bradley   R. . Self-directed mindfulness training and improvement in blood pressure, migraine frequency, and quality of life. . Glob Adv Health Med . 2013; ;2: 2 : 20– 25 .
    [Google Scholar]
  32. [32]. Mosier   J., , Roper   G., , Hays   D., , Guisto   J. . Sedative dosing of propofol for treatment of migraine headache in the emergency department: A case series. . West J Emerg Med . 2013; ;14: 6 : 646– 649 .
    [Google Scholar]
  33. [33]. Ward   DI., , Mulcahy   R., , Bailey   P., , Morgan   D. . Use of intravenous propofol in the treatment of migraine headache. . EMA . 2013; ;25: 6 : 619 .
    [Google Scholar]
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  • Article Type: Research Article
Keyword(s): emergency department , headache and Migraine disorders
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