Most with severe headache avoid emergency care

NEW YORK Fri Jan 30, 2009 2:00pm EST

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NEW YORK (Reuters Health) - Despite the pervasiveness of migraine and other headache disorders in the U.S., most individuals suffering a severe headache steer clear of emergency departments, survey findings suggest.

"The patients most likely to use the ED for management of headache were those who used the ED for management of everything," Dr. Benjamin W. Friedman, of Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, New York, told Reuters Health.

This group accounted for 51 percent of all ED visits reported by the survey participants over one year, Friedman and colleagues report in the journal Headache.

"It may be worthwhile for hospital administrators to identify these patients and figure out how to make primary care accessible for them," Friedman suggests.

Friedman's group mailed questionnaires to 24,000 participants of the American Migraine Prevalence and Prevention study to determine their type of headache and factors contributing to their ED use for treatment of these headaches during 2005.

Tallies from the 13,451 respondents show 94 percent did not visit an emergency department seeking headache relief. About 3 percent reported one ED visit and another 3 percent said they visited an ED for headache relief more than once during the 12-month period.

Of these, just one percent reported frequent (4 or more) ED visits during the previous 12 months, mostly due to unbearable pain (79 percent) or the inaccessibility of their primary care doctor (63 percent).

Another 26 percent sought better or different medications, and 23 percent cited concern over the significance of their pain.

Factors independently associated with frequent ED use included increasing disease severity, depression, lower socioeconomic status, and a predilection for using emergency departments for other medical care.

Friedman and colleagues suggest overall ED use might drop through interventions aimed toward such high-use individuals.

Additionally, primary care doctors, knowing that migraine sufferers are more likely to use the ED, could develop contingency plans with these patients to avoid an ED visit, Friedman said.

SOURCE: Headache, January 2009.

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