Researchers from Graham Headache Center, Brigham and Women’s Faulkner Hospital, Boston and Emergency Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York wanted to understand why patients with migraine go to an emergency department (ED).

Migraine accounts for more than 800,000 ED visits each year, and is a significant public health problem with substantial medical and economic consequences.

The researchers interviewed 309 patients presenting at an urban ED for headache. Patients were asked 100 closed-ended questions regarding headache history, current headache attack and sociodemographics. If brain imaging and spinal fluid analyses had been done, the results were recorded. Two ED physicians coded the headache type based on the International Classification of Headache Disorders, 2nd Edition criteria.

Of 186 patients who met the criteria for migraine, 77% had a primary care provider (PCP), approximately 90% had medical insurance and 83% had drug coverage. 53% said they had previously visited a doctor for headache, and 55% had previously received a migraine diagnosis.

The most common reason for visiting the ED was a perceived emergency condition, or a referral by a doctor. Another frequent reason related to access to care.

The study found that most migraineurs presenting to the ED have a PCP and healthcare insurance. ED visits resulted from an inability to access care elsewhere, and because patients considered their pain to be an emergency condition. The researchers also believed missed opportunities for diagnosis and treatment likely contributed to ED visits…..  Headache  The Journal of Head and Face Pain    June  2014

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