Emergency department (ED) utilization rates did not differ between patients with migraine who did and did not have an active triptan prescription, according to research results published in Headache.
Researchers conducted a retrospective cohort study to evaluate and describe migraine-specific medication-prescribing patterns in patients with migraine who used ED services compared with patients who did not. The primary study outcome was the proportion of patients with an active triptan prescription at the index date.
Eligible participants included adults under the care of a University of Colorado Medicine primary care provider with a migraine diagnosis as of July 1, 2018. Researchers manually reviewed patient charts to identify “potentially preventable circumstances” that led to an ED visit.
In total, the final analysis included 3843 patients (80% women; 71% White; median age, 45 years). During the 1-year observation period after the index date, only 0.9% of patients visited the ED for headache; patients in this group were younger than patients who did not use ED services (median age, 40 vs 45 years; P =.015). More patients in this group also had comorbid anxiety (34% vs 22%).
The primary outcome was similar between patients who did and did not use ED services (49% vs 36%); however, investigators found that more people who used the ED had active prescriptions for preventive migraine therapy compared with people who did not (54% vs 30%; P =.002). More of these patients also had prescriptions for opioid therapy (31% vs 17%; P =.03). Researchers noted no statistically significant difference for prescriptions for nonopioid, nontriptan prescriptions between groups.
The most commonly cited reason for ED visits was nonresponse to the prescribed migraine medication administered at home. Among other nonresponders, 8 classified their migraines as atypical from previous headaches, and another 8 said their migraines were consistent. Five patients specified that migraine symptoms had been ongoing for 1 week before ED admission. The second most common reason for ED utilization was not having migraine medications available at home.
The researchers concluded that 3 factors were statistically significantly associated with migraine-related ED use: a history of previous ED use for any indication (odds ratio [OR] 6.2 [95% CI: 2.92-13.16]), a history of neurology referral in the previous year (OR 3.18 [95% CI: 1.45-6.97]), and decreasing patient age (OR 1.04 [95% CI: 1.02, 1.07]).
Study limitations include the small sample size of people who used ED services, inconsistent migraine documentation, and the inability to confirm migraine medication adherence.
“[T]riptan prescribing did not differ between ED utilizers and non-ED utilizers for migraine,” the researchers concluded. “Further research and clinical initiatives to increase prescribing of evidence-based migraine medications… may help reduce rates of migraine-related ED use.”
Cheng V, Billups SJ, Saseen JJ. Prescribing practices of migraine-specific pharmacotherapy associated with emergency department use for migraine. Published online December 30, 2020. Headache. doi: 10.1111/head.14029