title: Epidemiology of intravenous fluid use for headache treatment: Findings from the National Hospital Ambulatory Medical Care Survey.
abstract: BACKGROUND
  Headache is one of the most common reasons for patients to seek care in emergency departments. While the administration of intravenous fluids is frequently recommended for emergency department patients with migraine, the epidemiology of the use of this intervention is unknown.
  
  
  OBJECTIVE
  To describe the epidemiology of intravenous fluid use in emergency department patients with headache.
  
  
  METHODS
  This retrospective study utilized the 2011 US National Hospital Ambulatory Medical Survey, a multi-stage weighted survey providing nationally representative estimates of ED visits. Patients with chief complaints of non-traumatic headache or migraine headache were included. We determined the frequency of intravenous fluid administration among patients presenting with headache, and among specific subgroups including those with migraine headache.
  
  
  RESULTS
  There were 1251 sample cases representing 5,981,000 visits for a chief complaint of headache. Intravenous fluids were administered at 40% (95% CI 35-44%) of these visits. Among the 222 migraine cases, 47% (95% CI 39-56%) received fluids. Fluids were commonly administered regardless of pain severity, and fluid administration was not significantly associated with pain severity among patients diagnosed with migraine (p=0.39). After adjusting for patient characteristics, ED visit duration remained greater for patients receiving fluids than for those who did not among both patients with a headache complaint and among those with a diagnosis of migraine headache.
  
  
  CONCLUSIONS
  Despite a lack of efficacy data, patients treated in United States EDs for headache frequently receive IV fluids. Studies are needed to determine the efficacy of this basic treatment intervention.
authors.affiliation: Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA. Electronic address: jones-christopher@cooperhealth.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Jones
authors.affiliation: Cooper Research Institute, Cooper University Hospital, Camden, NJ, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.affiliation: TRYUMPH Research Program, Anesthesiology Department, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina, Departments of Anesthesiology and Emergency Medicine, Chapel Hill, NC, USA.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000706:statistics & numerical data; D006261:Headache / Q000453:epidemiology / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Emergency department; Headache; IV fluids; Intravenous fluids; Migraine