1887
Volume 2016, Issue 3
  • ISSN: 1999-7086
  • EISSN: 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
2024-03-28
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References

  1. Evans RW, Friedman BW. Headache in the emergency department. Headache. 2011; 51:8:12761278.
    [Google Scholar]
  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; 49:4:409419, 19. e1–e9.
    [Google Scholar]
  3. Sahai-Srivastava S, Desai P, Zheng L. Analysis of headache management in a busy emergency room in the United States. Headache. 2008; 48:6:931938.
    [Google Scholar]
  4. Gelfand AA, Goadsby PJ. A Neurologist's guide to acute migraine therapy in the emergency room. Neurohospitalist. 2012; 2:2:5159.
    [Google Scholar]
  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; 28:4:383391.
    [Google Scholar]
  6. Beran R. Management of chronic headache. Aust Fam Physician. 2014; 43::106110.
    [Google Scholar]
  7. Kelly AM, Walcynski T, Gunn B. The relative efficacy of phenothiazines for the treatment of acute migraine: A meta-analysis. Headache. 2009; 49:9:13241332.
    [Google Scholar]
  8. Saguil A, Lax JW. Acute migraine treatment in emergency settings. Am Fam Physician. 2014; 89:9:742744.
    [Google Scholar]
  9. Kelly AM. Migraine: Pharmacotherapy in the emergency department. West J Med. 2000; 173:3:189193.
    [Google Scholar]
  10. Logan P, Lewis D. Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. Chlorpromazine in migraine. EMJ. 2007; 24:4:297300.
    [Google Scholar]
  11. Stark RJ, Stark CD. Migraine prophylaxis. Med J Aust. 2008; 189:5:283288.
    [Google Scholar]
  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; 380:9859:21632196.
    [Google Scholar]
  13. Steiner TJ, Stovner LJ, Birbeck GL. Migraine: The seventh disabler. Headache. 2013; 53:2:227229.
    [Google Scholar]
  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; 84:12:13091317.
    [Google Scholar]
  15. Wober-Bingol C, Wober C, Uluduz D, Uygunoğlu 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. 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; 23:7:519527.
    [Google Scholar]
  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; 21:4:333334.
    [Google Scholar]
  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; 296:10:12741283.
    [Google Scholar]
  19. Martin VT, Penzien DB, Houle TT, Andrew ME, Lofland KR. The predictive value of abbreviated migraine diagnostic criteria. Headache. 2005; 45:9:11021112.
    [Google Scholar]
  20. Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 2: Neuroleptics, antihistamines, and others. Headache. 2012; 52:2:292306.
    [Google Scholar]
  21. Krymchantowski AV, Barbosa JS. Prednisone as initial treatment of analgesic-induced daily headache. Cephalalgia. 2000; 20:2:107113.
    [Google Scholar]
  22. Boe MG, Mygland A, Salvesen R. Prednisolone does not reduce withdrawal headache: A randomized, double-blind study. Neurology. 2007; 69:1:2631.
    [Google Scholar]
  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; 25:1:2629.
    [Google Scholar]
  24. Inan LE, Inan N, Karadas O, Gül HL, Erdemoğlu 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; 132:4:270277.
    [Google Scholar]
  25. Williams DR, Stark RJ. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia. 2003; 23:10:963971.
    [Google Scholar]
  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; 73:12:970977.
    [Google Scholar]
  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; 9:4:373380.
    [Google Scholar]
  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. 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; 293:17:21182125.
    [Google Scholar]
  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. 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; 2:2:2025.
    [Google Scholar]
  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; 14:6:646649.
    [Google Scholar]
  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 departmentheadache and Migraine disorders
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