Headache Specialists Dissatisfied With Migraine Care in the ED

Emergency department (ED) visits for migraine are prevalent and create a burden on the patients and healthcare system, and many headache specialists are not satisfied with the care their patients receive in the ED, demonstrating the need for more standardized protocols for ED visits by patients with known headache disorders.

A recent study, published by Wiley Periodicals, conducted a survey among members of the American Headache Society (AHS) Emergency Departments/Refractory/Inpatients Section in order to understand whether headache specialists use headache management protocols, the strategies they use to try and reduce the number of ED visits for migraine, and whether protocols are used in the EDs with which they are affiliated. They also assessed the level of satisfaction with the coordination of care between headache specialists and the ED.

“People with migraine who seek care from a headache specialist may call the headache specialist, make urgent visits to the headache center, or go directly to the ED with or without notifying their practitioner,” the authors explained. “However, the ED is a suboptimal place for treatment because of the high charges, the long waits for treatment in a bright, noisy environment, and because ED care for migraine is often suboptimal.”

Of the 96 eligible AHS members, 50 responded to the questionnaires by email or in person.

Of the responses, 59% reported giving rescue treatment to their patients to manage acute attacks, and 54% reported using standard protocols for outpatients not responding to usual acute treatments.

In the event of a request for urgent care, 12% of specialists reported bringing patients into the office most or all of the time, while 20% reported sending patients to the ED some or most of the time for headache management. Also, 36% reported prescribing a new medicine and 30% reported providing telephone counseling some/most/all of the time. Furthermore, 60% reported their ED has a protocol for migraine management and 38% of the total responses were usually or very satisfied with the headache care in the ED.

The majority of participants also expressed dissatisfaction with ED management of headache patients, with 4% reporting not satisfied, 18% reporting often not satisfied, and 40% reporting inconsistently satisfied.

“Given that close to two-thirds (62%) were inconsistently/often not/or not satisfied with ED management of their headache patients, there may be room for improvement in headache patients’ care. To reduce the high number of headache patients in the ED, education and intervention methods can be taught to patients, as well as step-wise elaboration of medications and treatment plans, when initial therapy foes not work,” concluded the authors.

The researchers suggested additional studies on the preferred methods of communication between headache specialists and ED providers.