Migraine and Headache in the ER - New Report
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:
There's no surprise in the statistics showing more visits for women than men given that Migraine strikes women three times as often as men.
The statistics that aren't available in this report that I think would be quite relevant is how many of these ED visits could be avoided if patients had rescue treatments available to use at home. For Migraineurs, rescue treatments are those that are used when Migraine abortive medications fail or can't be used for some reason. Certainly, there will be times when ED treatment is necessary, but when rescue treatments are made available as part of a comprehensive Migraine management regimen, many Migraineurs find that they can eliminate many if not all ED trips. For more about rescue treatments, see Preventive, Abortive, and Rescue Medications - What's the Difference?
Another statistic missing from this report is the success or failure of ED treatment. Partly due to misconceptions and stigma, and partly due to lack of physician education and understanding of Migraine, too many Migraineurs receive inadequate ED treatment or are even accused of "drug-seeking" and given ineffective treatment in the ED. In a growing trend, many EDs and urgent care facilities now have signs posted stating that they do not treat "headaches," or that they don't treat them with narcotics.
While there will always be some cases where the ED is the appropriate setting for Migraine or headache treatment, better physician and patient understanding of Migraine and other headache disorders would foster better disease management and reduce the overall need for ED treatment.
1 Lucado, Jennifer, M.P.H.; Paez, Kathryn, Ph.D., M.B.A., R.N.; Elixhauser, Anne. Ph.D. "Headaches in U.S. Hospitals and Emergency Departments, 2008." Agency for Healthcare Research and Quality. May, 2011.
2 Terbush, Sophie. "Headaches send 3M people to emergency rooms." USAToday.com. May 23, 2011.