Neurology department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Zaragoza, Spain.
Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain.
Intern Emerg Med. 2021 Nov;16(8):2243-2249. doi: 10.1007/s11739-021-02698-9. Epub 2021 Mar 12.
To assess the characteristics of the management of patients with migraine who present to the emergency department (ED) with a migraine attack. Retrospective, observational study analyzing demographic, clinical, diagnostic and therapeutic characteristics of patients with migraine diagnosis presenting to ED for a migraine attack between 2016 and 2019. We reviewed the clinical records of 847 cases. 82.2% were women with mean age of 34.9 years. 87.2% had episodic migraine and 12.2% chronic migraine. 62.3% (528/847) had taken analgesics before visiting the ED [non-steroidal-anti-inflammatory drugs (NSAIDs) (300/528; 56.9%) and triptans (261/528; 49.5%)]. 25.4% (215/847) received blood testing and 6.4% (55/847) received cranial CT. Medication was administered in 77.2% cases (654/847). The median time-to-treatment was 70 min (IQR 42-120). NSAIDs (81%, 530/654), antiemetics (43.1%, 282/654) and metamizole (39% 255/654) were the most used. Triptans were administered in 7 cases (1.1%) and opioids in 84 (12.8%). At discharge, preventive treatment was prescribed or modified in 8.2% of cases (69/839) and triptans were prescribed in 129 cases (15.3%). 70.5% (592/839) were instructed to follow-up with their primary care provider (PCP), 21.5% (181/839) with a general neurologist and 7.9% (66/839) with a headache specialist. The majority of migraine patients were not receiving the recommended acute migraine-specific medication, both in the outpatient and in the ED setting, being especially remarkable the rare use of triptans in the ED. Furthermore, we found an elevated use of urgent complementary tests, mainly blood tests.
评估因偏头痛发作而到急诊科就诊的偏头痛患者的管理特点。这是一项回顾性、观察性研究，分析了 2016 年至 2019 年间因偏头痛发作到急诊科就诊的偏头痛患者的人口统计学、临床、诊断和治疗特征。我们回顾了 847 例患者的临床记录。82.2%为女性，平均年龄为 34.9 岁。87.2%为发作性偏头痛，12.2%为慢性偏头痛。62.3%（528/847）在就诊前曾服用过镇痛药[非甾体抗炎药（NSAIDs）（300/528；56.9%）和曲普坦类（261/528；49.5%）]。25.4%（215/847）接受了血液检查，6.4%（55/847）接受了头颅 CT 检查。77.2%的病例（654/847）接受了药物治疗。治疗中位时间为 70 分钟（IQR 42-120）。最常使用的药物为 NSAIDs（81%，530/654）、止吐药（43.1%，282/654）和氨基比林（39%，255/654）。仅 7 例（1.1%）使用了曲普坦类，84 例（12.8%）使用了阿片类药物。出院时，8.2%（69/839）的病例调整或开始预防性治疗，129 例（15.3%）开了曲普坦类药物。839 例中有 70.5%（592/839）被建议到初级保健提供者（PCP）处就诊，21.5%（181/839）到普通神经科医生处就诊，7.9%（66/839）到头痛专科医生处就诊。大多数偏头痛患者在门诊和急诊科都没有接受推荐的急性偏头痛特异性药物治疗，特别是在急诊科很少使用曲普坦类药物。此外，我们发现急诊常进行不必要的补充检查，主要是血液检查。
