Emergency management of migraine: is the headache really over?

OBJECTIVES: To observe headache frequency after release for acute migraine sufferers treated in an ED; to observe the impact after-release headaches and associated symptoms have on quality of life; and to document the variability in migraine management in an emergency setting. METHODS: Prospective observational study, including 24- and 72-hour telephone follow-up. RESULTS: Over a 4-month period, 143 patients with headaches (149 visits) were observed in the ED. Of 108 patients successfully contacted, the incidence of headache in the first 24 hours after release was 49.1%. Forty-two patients left the ED without pain; 13 of these subsequently had return of headache. Sixty-six left with some degree of pain, with 40 having headache persistence at 24 hours. The difference in 24-hour headache rate between the 2 groups is significant (p=0.008). Five patients still had headaches at 72 hours after release, but 54 of 70 contacted had taken medication for their symptoms between 24 and 72 hours after release. Forty-five percent were not back to normal function at 24 hours, while 21 of 70 were still not sleeping well at 72 hours. Finally, 8 different classes of medications were used in the ED for migraine headaches, with 20 patients receiving at least 3 types of medication. CONCLUSIONS: Treatment for acute migraine headache in this emergency setting was variable. Patients not obtaining complete relief in the ED had a higher rate of headache after release than did those who left with no pain. Migraine sufferers may have normal daily function affected for up to 72 hours or longer after ED treatment.