Cheng Vivian, Billups Sarah J, Saseen Joseph J
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Headache. 2021 Mar;61(3):455-461. doi: 10.1111/head.14029. Epub 2020 Dec 30.
This study compared migraine medication prescribing between patients with a migraine diagnosis who used versus did not use the emergency department (ED) for migraine.
Headache is the fifth most common chief complaint for ED visits nationwide and the third most common potentially avoidable ED diagnosis in the University of Colorado Health system. The reasons some patients use the ED for migraine management while others do not and whether some ED admissions might be preventable remain unclear.
This retrospective cohort study identified adults with migraine-related diagnoses within 1 year before the index date of July 1, 2018 and compared patient characteristics and migraine medication prescribing patterns between those who did or did not have a subsequent migraine-related ED encounter the following year. ED admission notes were manually reviewed to identify potentially preventable circumstances that led to the ED visit. The primary outcome was the proportion of patients with an active triptan prescription at the index date.
Of the 3843 patients identified, 35 patients (0.9%) had a migraine-related ED encounter. Of these, 17/35 (49%) had an active triptan prescription compared to 1360/3808 (36%) of non-ED utilizers (p = 0.114), OR 1.22 (95% CI 0.61-2.45). More ED utilizers had an active prescription for opioids (11/35 [31%] vs. 663/3808 [17%], p = 0.030) and migraine preventive therapy (19/35 [54%] vs. 1149/3808 [30%], p = 0.002), and neurology referrals (20/35 [57%] vs. 654/3808 [17%], p < 0.001) compared to non-ED utilizers. The most common circumstance for migraine-related ED visits was nonresponse to migraine abortive medications administered at home.
Triptan prescribing did not differ between ED utilizers and non-ED utilizers for migraine. Overall, less than half of the total patient population had a triptan prescribed. More ED utilizers had neurology referrals, prescriptions for opioids and preventive therapies, and a history of previous ED visit for any reason, which may be markers for higher disease severity or behavior patterns. Future research and interventions to reduce migraine-related ED use could target high-risk patients such as those with previous ED visits for any indication and neurology referrals.
本研究比较了诊断为偏头痛的患者中，使用与未使用急诊科（ED）治疗偏头痛的患者之间偏头痛药物的处方情况。
头痛是全国急诊科就诊的第五大常见主要症状，在科罗拉多大学健康系统中是第三大常见的潜在可避免的急诊科诊断。一些患者使用急诊科治疗偏头痛而另一些患者不使用的原因，以及一些急诊科就诊是否可以预防尚不清楚。
这项回顾性队列研究确定了在2018年7月1日索引日期前1年内有偏头痛相关诊断的成年人，并比较了次年有或没有后续偏头痛相关急诊科就诊经历的患者的特征和偏头痛药物处方模式。人工查阅急诊科入院记录以确定导致急诊科就诊的潜在可预防情况。主要结局是在索引日期有活性曲坦类药物处方的患者比例。
在确定的3843例患者中，35例（0.9%）有偏头痛相关的急诊科就诊经历。其中，17/35（49%）有活性曲坦类药物处方，而未使用急诊科的患者为1360/3808（36%）（p = 0.114），比值比为1.22（95%可信区间0.61 - 2.45）。更多使用急诊科的患者有阿片类药物活性处方（11/35 [31%] 对 663/3808 [17%]，p = 0.030）、偏头痛预防性治疗（19/35 [54%] 对 1149/3808 [30%]，p = 0.002）以及神经内科转诊（20/35 [57%] 对 654/3808 [17%]，p < 0.001）。与未使用急诊科的患者相比，偏头痛相关急诊科就诊最常见的情况是对在家中使用的偏头痛缓解药物无反应。
使用急诊科和未使用急诊科的偏头痛患者在曲坦类药物处方方面没有差异。总体而言，不到一半的患者有曲坦类药物处方。更多使用急诊科的患者有神经内科转诊、阿片类药物和预防性治疗的处方，以及既往因任何原因的急诊科就诊史，这可能是疾病严重程度较高或行为模式的标志。未来减少与偏头痛相关的急诊科使用的研究和干预措施可以针对高危患者，如既往因任何指征有急诊科就诊史和有神经内科转诊的患者。
