Emergency department visits for headache disorders, Migraine in particular, is the topic of a report issued this month by the Agency for Healthcare Research and Quality.

The report is based on emergency department (ED) date compiled for the year 2008. Please note that, in the context of this report, unless otherwise noted, the term "headache" means all headache disorders, including Migraine.

Audrey Halpern - clinical assistant professor of neurology, New York University School of Medicine; director, Manhattan Center for Headache and Neurology - commented that hormones, genetics, and the differences between male and female brains may play a role in Migraine. She also commented on how severe and disabling Migraines can be, saying,

"Patients come in and think they're going to die."²

Dr. Jason Rosenberg; - assistant professor neurology, Johns Hopkins University; director, Johns Hopkins Headache Center - noted that those who seek ED care for Migraines and headaches usually either have pain so severe that they need immediate relief, or fear they may have a life-threatening condition.

Highlights of the report:

• In 2008, headaches were the first-listed diagnosis for over 3 million ED visits (comprising 2.4 percent of all ED visits) and 81,000 inpatient stays (comprising 0.2 percent of all inpatient stays).
• Migraines were the most common type of headache associated with inpatient stays, comprising 63.1 percent of all hospital stays with headache as a first-listed diagnosis.
• Nearly three out of four headache-related ED visits and inpatient stays were for females. For migraine, specifically, rates of ED visits were 4.6 times higher among females than males and rates of inpatient stays were 3.7 times higher for females.
• The highest rate of ED visits for first-listed diagnosis of headache was in the 18 to 44 year age group, with 1,626 visits per 100,000 population. The rate of inpatient stays with headache as a first-listed diagnosis was significantly higher in the 18 to 44 and 45 to 64 year age groups (32.6 and 35.7 per 100,000 population, respectively) than other age groups.
• ED visits were higher in rural areas and among patients in the lowest income quartile, where the rate of ED visits was 2.3 times higher than in the wealthiest communities. There were no differences in headache hospitalization rates by rural/urban location and income.
• The West had the lowest rate of ED visits and hospitalizations for headache. ED visits were also lower in the Northeast compared to the South and Midwest, but hospitalization rates for the Northeast were the highest of all regions.
• Hospitalizations for headache tended to be shorter (2.7 days) compared to the overall average hospital stay of 4.6 days. Similarly, the average cost per headache stay was less than the average cost of an inpatient stay ($5,000 vs. $9,200), although costs per day were comparable ($1,900 per day for headache stays and $2,000 for all stays).
• Hospital treatment for patients with headache as the main reason for hospitalization cost $408 million in 2008.

Summary and comments: