"In a growing trend, many EDs and urgent care facilities now have signs posted and do not treat "headaches.""
Wow Teri -- is this true? Is this just anecdotal? Or do you have evidence? Would love to know more.
Thanks!
Joanna
Joanna,
Depends on what you mean by "proof." I don't know of any studies are gathered data, but I've had people tell me that's what they've found in both ER's and in urgent care centers. In ER's, it's more likely to be signs saying that they don't treat "headaches" with narcotics. I saw it for myself in an urgent care center here back in December. I was there for something else, but of course, noticed the sign. When I asked the about it, they said they send anyone who comes in with a Migraine or headache to the ER because they don't have the equipment to do imaging.
Teri
You're welcome, Joanna. I knew what you meant -- something documented as opposed to anedcotal. 
IMO, something that needs to change is how many people use the ER for Migraine treatment. ER's should be reserved for true emergencies, and Migraine treatment shouldn't become an emergency. That's what I was talking about near the end of the article - having a complete management regimen that has contingencies for times when our regular medications don't work. That happens to all of us sometimes, and if our doctors help us plan for it, it would seldom become an emergency. That way, we'd have better treatment with less difficulty and stress.
Teri
Teri: I hope you are feeling better by now.
Thank you for sharing this study and also your additional insights. It does pose more questions.
I wondered why the study did not mention ER costs also, which are hefty, and perhaps avoidable if EFFECTIVE rescue meds were prescribed.Locations where I have lived/visited/travelled and have been forced (due to inadequate rescue meds) to seek ER treatment (Pennsylvania, North Carolina, Florida, and Northern CA), the cost for emergency room treatment has varied significantly. The cost for ER treatment has ranged from $1700 to $3400.
While no ER physician has ever withheld treatment from me (maybe because I am clincially dehydrated, visibly debilitated, BP escalated, and in severe pain) or accused me of being a drug seeker, it is some of the headache SPECIALISTS in my case who will not prescribe effective rescue meds (as per your observation). The reasons have been ridiculous, and I am shocked that my specialist (and my HMO neurologists) would rather NOT prescribe adequate rescue med, while I then face increased health risks of complications of uncontrolled migraines (strokes, hypnic headaches, kidney disfunction from repeated and severe dehydration). Yet they are willing to pay $3200 several times a year for ER treatment. Due to the need for ER visits, I run the additional risks of hospital infections, a botched IV "push" that could result in losing a limb, a crash in an ambulance, etc.
Sorry, I am venting. I suspect that a pharmo-economic analysis would divulge that undercontrolled migraines are costing MUCH more than effective outpatient treatment and preventative treatment would cost. Aside from the cost issue, the increased health risks--in addition to increased span of being in severe pain, loss of work, loss of functionality, reduced quality of life--are reasons enough that EFFECTIVE rescue treatment should be incorporated into routine protocols for patient therapy.
Hugs, Clemmie
Hi, Clemmie,
I am feeling better; thanks for asking.
The AHRQ report is part of the federal Healthcare Cost and Utilization Project. It's set up to look at healthcare as a whole. The only reason they issued a report on "headache" is that it does use such a significant portion of ER visits. In other words, this wasn't a headache and Migraine study. That's why there weren't more specific questions. The answers to the questions we'd have liked to see would have been very telling, but probably wouldn't have been considered within the scope of the project.
No need to be sorry for venting. I can well understand your frustration. Your situation is far from what it should be. I first learned about rescue medications from Dr. Young when I was seeing him at the Jefferson in Philadelphia. Now, it's one of the first questions I'd ask a doctor I was thinking about seeing for ongoing care, and -- if possible -- no doctor would be my doctor unless he or she were willing to work with me on rescue treatment to help me stay out of the ER. I'm just sorry that your doctor isn't willing to do this.
Hugs back to you,
Teri
Hi Teri:
Thanks so much for your analysis of this report and for your feedback and encouragement. I did look into the very few other headache specialists within an 10 hour drive, and found that most have little or no experience with Hypnic headaches. The one that does charges $800 for the first patient visit. But I am realizing that it is important, and it is less expensive than travelling to some place like Mayo Clinic.
No need to reply. Just wanted you to know that I took your message to heart, and appreciate all that you do for us and for me.
Take great care,
Clemmie
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thanks for commenting on this article.. the first page- of pure stats- had me wondering some of the same questions you posed in your second page of this sharepost.
I think this poses more questions than answers without information regarding Migraine vs. ha-- admission for what reason- HA as part of syndrome or genuine HA? Migraine admission? or is it HA admission? If it's for Migraine admission is it for a protocol, or b/c something else was found? or medical lack of knowledge re: resolving Migraine?
The info re: regional differences is interesting, but I don;t know what to make of it, vis=a- vis rurality, weather, quality of treatment professionals, etc...
Ick. Too many thoughts, not enough brainpower.
Ok, those thoughts were based on summary alone. Will have to read the full report when the room stops spinning.