title: A randomized controlled trial of a comprehensive migraine intervention prior to discharge from an emergency department.
abstract: OBJECTIVE
  Patients who use an emergency department (ED) for acute migraine headaches have higher migraine disability scores, lower socioeconomic status, and are unlikely to have used a migraine-specific medication prior to presentation to the ED. The objective was to determine if a comprehensive migraine intervention, delivered just prior to ED discharge, could improve migraine impact scores 1 month after the ED visit.
  
  
  METHODS
  This was a randomized controlled trial of a comprehensive migraine intervention versus typical care among patients who presented to an ED for management of acute migraine. At the time of discharge, for patients randomized to comprehensive care, the research team reinforced their diagnosis, shared a migraine education presentation from the National Library of Medicine, provided them with six tablets of sumatriptan 100 mg and 14 tablets of naproxen 500 mg, and if they wished, provided them with an expedited free appointment to the institution's headache clinic. Patients randomized to typical care received the care their attending emergency physicians (EPs) felt was appropriate. The primary outcome was a between-group comparison of the Headache Impact Test (HIT-6) score, a validated headache assessment instrument, 1 month after ED discharge. Secondary outcomes included an assessment of satisfaction with headache care and use of migraine-specific medication within that 1-month period.
  
  
  RESULTS
  Over a 19-month period, 50 migraine patients were enrolled. One-month follow-up was successfully obtained in 92% of patients. Baseline characteristics were comparable. One-month HIT-6 scores in the two groups were nearly identical (59 vs. 56, 95% confidence interval [CI] for difference of 3 = -5 to 11), as was dissatisfaction with overall headache care (17% vs. 18%, 95% CI for difference of 1% = -22% to 24%). Patients randomized to the comprehensive intervention were more likely to be using triptans or migraine-specific therapy (43% vs. 0%, 95% CI for difference of 43% = 20 to 63%) 1 month later.
  
  
  CONCLUSIONS
  A comprehensive migraine intervention, when compared to typical care, did not improve HIT-6 scores (a validated measure of the effect of migraine on one's daily life) 1 month after ED discharge. Future work is needed to define a migraine intervention that is practical and useful in an ED, where many underserved patients, of necessity, present for care.
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. befriedm@montefiore.org
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Friedman
authors.forename: Clemencia
authors.initials: C
authors.lastname: Solorzano
authors.forename: Jennifer
authors.initials: J
authors.lastname: Norton
authors.forename: Victoria
authors.initials: V
authors.lastname: Adewumni
authors.forename: Caron M
authors.initials: CM
authors.lastname: Campbell
authors.forename: David
authors.initials: D
authors.lastname: Esses
authors.forename: Polly E
authors.initials: PE
authors.lastname: Bijur
authors.forename: Seymour
authors.initials: S
authors.lastname: Solomon
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.forename: E
authors.initials: E
authors.lastname: John Gallagher
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D009288:Naproxen / Q000627:therapeutic use*; D010351:Patient Discharge; D012720:Severity of Illness Index; D018170:Sumatriptan / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D009288:Naproxen; D018170:Sumatriptan