Original ContributionsTreatment patterns of isolated benign headache in US emergency departments*,**
Introduction
Headache is a common condition in the United States for which emergency medical attention is frequently sought.1, 2 At the physician's disposal is an array of pharmacotherapeutic options. For mild-to-moderate headaches not associated with vomiting, a variety of oral agents and a large number of combinations are available. For moderate-to-severe headaches and those associated with vomiting, several categories of parenteral medications are in use, including oxygen, saline solution, nonsteroidal anti-inflammatory drugs, dopamine-antagonist antiemetics, ergotamines, 5-hydroxytrypamine1 (5-HT1) receptor agonists, mixed opioid agonist-antagonists, and opioid agonists. The efficacies, hazards, and costs of these respective therapies have been carefully reviewed.3, 6
For the management of acute migraine headache, guidelines exist that both rank the level of evidence supporting the use of each medication and recommend sensible treatment strategies.7, 8 There is, however, little specific information available regarding current treatment patterns in the United States. The number and types of medications used in emergency medicine for the relief of primary headache disorders have not been examined. Thus, this study was undertaken to describe the treatment of emergency department patients given a diagnosis of benign headache by using a US government national database.
Section snippets
Materials and methods
Data for this study were obtained from the 1998 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention.9 The NHAMCS studies patient visits to nonfederal, short-stay hospital EDs; chronic-care, military, and Veterans Administration hospitals are excluded. Hospitals with average lengths of stay for all patients of less than 30 days and with specialties of
Results
On the basis of weighted national data, approximately 100.4 million ED visits occurred in 1998. Nearly 5.2 million (5.1%) patients reported that headache or migraine headache was 1 of their 3 chief reasons for the ED visit. Of all the patients with a primary ED diagnosis of migraine headache, 811,419 (81%) patients met our study criteria. Only 604,977 (49%) patients with a primary ED diagnosis of unspecified headache met the inclusion criteria. The presence of coexisting diagnoses was the
Discussion
This study demonstrates that headache is a common complaint among US ED patients, many of whom report moderate-to-severe pain. Thirty-six drugs were used in 1998 in the abortive treatment of ED-diagnosed headache. Polypharmacy appears routine because most patients received at least 2 classes of medication. Parenteral agents were commonly used. The most frequently administered medications among all participants in this study were meperidine, ketorolac, and prochlorperazine, in that order.
When
Acknowledgements
I thank Dr. John Edmeads for his critical review of an earlier version of the manuscript.
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Address for reprints: David R. Vinson, MD, Department of Emergency Medicine, Kaiser Permanente Medical Center, 1600 Eureka Road, Roseville, CA 95661-3027.
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Author contribution is provided at the end of this article. Author contribution: DRV is the sole author and takes responsibility for the paper as a whole.