Utilization, diagnosis, treatment and cost of migraine treatment in the emergency department.
OBJECTIVE
To determine the percentages of patients receiving migraine-specific therapy and to estimate the rate of unnecessary neuroimaging studies in the emergency department (ED).


METHODS
A retrospective study was conducted analyzing medical records and hospital charge data of ED visits for migraine during 2005 in 2 university-affiliated hospitals. Following a preliminary review of 23 randomly selected ED charts selected to determine the reliability of the coding process, 172 other charts were selected to include 1 visit per patient with a primary discharge diagnosis code of 346.0, 346.1, or 346.9. The diagnosis of migraine was confirmed using predefined criteria. Demographic information, treatment strategies, laboratory and neuroimaging tests, response to therapy, discharge planning, and charge data were evaluated.


RESULTS
Of 156 patients with completed visits, neuroimaging studies were performed in 36 patients (23%), and only 4 patients had no documented justification for obtaining imaging studies. Seventy-eight patients (50%) had a potential contraindication to receiving migraine-specific therapy. Nine patients (11.5% of eligible patients) received migraine-specific therapy. Most patients were treated with a combination of parenteral antiemetics, narcotics, or ketorolac.


CONCLUSIONS
This analysis supports previous studies indicating the underutilization of migraine-specific treatment in the ED, and suggests that the ED is generally used as a "last resort" when the patient's home medication fails. Because of various contraindications, migraine-specific medications may not be a treatment option in up to 50% of patients seen in the ED. Although almost all of the neuroimaging studies were justified, the radiology charges were a major contributing factor to the overall financial burden of emergency migraine care.
Friedman
Deborah
D
University of Rochester, Neurology, Rochester, NY, USA.
Feldon
Steven
S
Holloway
Robert
R
Fisher
Susan
S
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics* / Q000706:statistics & numerical data*; D004879:Ergotamines / Q000627:therapeutic use; D005260:Female; D005568:Forms and Records Control; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D008881:Migraine Disorders / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D009294:Narcotics / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012189:Retrospective Studies; D014363:Tryptamines / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D004879:Ergotamines; D009294:Narcotics; D014363:Tryptamines; D020910:Ketorolac