EMERGENCY MANAGEMENT OF MIGRAINE - IS THE HEADACHE REALLY OVER

Objectives: To observe headache frequency after release for acute migr aine sufferers treated in an ED; to observe the impact after-release h eadaches and associated symptoms have on quality of life; and to docum ent the variability in migraine management in an emergency setting. Me thods: Prospective observational study, including 24- and 72-hour tele phone follow-up. Results: Over a 4-month period, 143 patients with hea daches (149 visits) were observed in the ED. Of 108 patients successfu lly contacted, the incidence of headache in the first 24 hours after r elease was 49.1%. Forty-two patients left the ED without pain; 13 of t hese subsequently had return of headache. Sixty-six left with some deg ree of pain, with 40 having headache persistence at 24 hours. The diff erence 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 betwe en 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 we ll 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 heada che in this emergency setting was variable. Patients not obtaining com plete relief in the ED had a higher rate of headache after release tha n did those who left with no pain. Migraine sufferers may have normal daily function affected for up to 72 hours or longer after ED treatmen t.