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Migraine in the Emergency Department: Not a Win-Win Situation |
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Hypothetical scene from the popular television show "ER": Enter Dr. Carrie Weaver, a no- nonsense attending. "Who has the migraine in 6? Why is she still here? Get her out of here! We have to make room for 4 teens with multiple GSWs." And therein lies the crux of the problem: how to provide rescue care for migraine, an episodic condition which may be incapacitating but is rarely life-threatening. The article by Blumenthal et al in a recent issue of Headache examines the emergency department (ED) experience for patients
with primary headache as extracted from patient questionnaires correlated to ED records. The authors draw attention to various issues inherent to the ED headache encounter, many of which have been reported by others in recent years. These previous studies have been criticized due to methodologic concerns regarding ascertainmet of subjects, incomplete documentation in ED records, lack of standardized diagnostic criteria and lack of 24- or 48-hour follow-up data. While the percentage of responders to the questionnaires utilized by Blumenthal was low, this is typical of this type of study, and some familiar themes emerged. These include underdiagnosis of migraine as the specific primary headache type and underuse of “migraine-specific” medication.
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