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How to Keep Migraine Patients From Coming Back to the ER

Quick, what’s the best thing to do with a patient who presents with an excruciating migraine headache? If you’re not quite sure, you’re not alone. Migraine is a problem that is largely overlooked by the emergency medical community. Yet some 12% of patients seeking care meet the criteria for migraine, and these patients disproportionately suffer from symptoms of anxiety and depression as well as other diagnosed co-morbidities. 

A study presented at the recent American Headache Society Annual Meeting, examined this challenge. Researchers including Mia T. Minen, MD, MPH, Chief of Headache Research, Assistant Professor Neurology, NYU Langone Health, New York, New York, hypothesized that, despite advances in treatment, patients with migraine go underdiagnosed and undertreated in urgent care settings. 

Dr. Minen and colleagues conducted a retrospective cohort study of headache visits from 67 NYC urgent care centers. There has been a rise in urgent care centers throughout the country over the past 10 years, leading to an increase in patients accessing medical care in these locations. These centers advertise an alternative to the Emergency Department (ED) for the evaluation and treatment of urgent medical conditions. 

Descriptive analyses were used to determine the frequency and elapsed time of revisit.

Of the 10,240 patients included in this study, 5.5% (N=564) had at least one revisit. The majority of patients, 6994 (68.3%) were female, and the mean age was 35.1 (SD: 15.0 years). 93.9% of patients (N=9613) lived within 60 miles of NYC. Among re-visitors, the mean frequency visit to urgent care was 2.2 (SD: 0.7 times), with an average revisit wait time of 61.3 days (SD: 55.2 days). 64.3% of revisits happened within 90 days. 


The goal of this analysis was to examine the use of urgent care visits for migraine within two centers in New York City. They examined the trends in management and treatment of migraine in these urgent care settings, as well as prescriptions and instructions given to this patient population upon discharge. They paid particular attention to whether the medications administered and prescribed on discharge were those recommended by American Headache Society migraine management guidelines.

The results: In just eight months, there were over 10,000 headache visits to urgent care centers in NYC, with half of revisits happening within 90 days. More than one-quarter of initial emergency department visits for migraine were followed by headache revisits in fewer than six months. Among patients discharged from the ED with a diagnosis of migraine, 12.5% revisit the same department for headache more than once within six months. 


In addition, they noted that great variability exists with respect to the diagnosis, management and treatment of migraine patients in urgent care settings as well as emergency departments. Migraine-specific treatments were underused. Furthermore, many departments lacked headache protocols and, often, migraine-specific treatment was not included in the few departments with protocols.

Future work should look at treatment administration at these centers to provide a better understanding of how to optimize headache management. For example, on discharge, patients should be advised about local headache treatment facilities. They should also be offered access to urgent care appointments or walk-in outpatient appointments, especially during off-hour nights and weekends.

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