CHICAGO – Headache is the fifth most common emergency department complaint, but only a small percentage of migraineurs use emergency care for treatment, according to an analysis of the American Migraine Prevalence and Prevention study presented at the annual meeting of the American Headache Society.
Dr. Benjamin Friedman of the Albert Einstein College of Medicine, New York, said he and his colleagues sought to determine how often Americans with headache use the ED or an urgent care facility, and what the risk factors were for frequent use.
The goal of the study was to discern ways to prevent urgent headache visits. Currently there are about 5 million visits a year for headache, he said.
The American Migraine Prevalence and Prevention study (AMPP) is an ongoing multisite survey that began in 2004 when a self-administered headache questionnaire was mailed to a random sample of 120,000 households. The study was supported by a grant to the National Headache Foundation from Ortho-McNeil Inc. Of the 162,576 individuals who responded, 30,721 self-reported severe headaches. Dr. Friedman and his colleagues mailed a follow-up survey in 2005 to a random subsample of 24,000 of the headache sufferers, asking for data on emergency or urgent care use within the previous 12 months.
Data were collected on 13,451 respondents. Among those categorized with migraine or probable migraine, 94% did not visit the emergency department at all, leaving 859 patients who did report a visit. Among those, 48% (412) reported only one visit within the past year. About a third (274) reported 2–3 visits, only 14% (120) reported up to nine visits, and 53 patients reported more than nine visits.
The frequent users, which he classified as 20% of the 859 ED visitors, accounted for 51% of all visits.
The most-cited reasons for going to the ED or urgent care facility included unbearable pain, the inability to reach a primary physician, the ability to get better or different medications, and concern about the significance of the pain (for instance, whether it might be the result of meningitis). A small number of patients said the ED was the primary source of care, and an equal number cited insurance or other financial barriers to care as the reason why they went to an urgent facility instead of a primary physician.
Using a multivariate analysis, Dr. Friedman and his colleagues determined that the main risk factors for urgent care use were the use of those facilities for nonheadache care and a severe migraine disability assessment scale (MIDAS) score. Having insurance was protective against ED visits, he said. The risk factors were similar in frequent ED users, with stronger associations.
The investigators concluded that urgent care facilities are used infrequently for the management of severe headache on a population level, but–because the disorder is so prevalent–headache is a common complaint in the ED. Frequent users are uncommon, but they account for the majority of visits to ED and urgent care. In terms of modifiable risk factors, ED use is associated with more severe headache, so treating the underlying headache may help prevent urgent care visits, Dr. Friedman said.
Dr. Friedman noted that the study is limited by its reliance on self-reporting of ED visits and because it is cross-sectional. Dr. Friedman reported no disclosures other than the study funding.