Emergency and Inpatient Treatment of Migraine: An American Headache Society Survey
Journal Title: Journal of Advances in Medicine and Medical Research - Year 2014, Vol 4, Issue 20
Abstract
Objective: To determine the medication and management preferences of headache specialists in treating migraine in the ED and during inpatient hospitalization. Background: Despite the frequency of migraine as a presenting complaint and the cost of acute treatment, there is no clear consensus on the standard of care for acute migraine management in the ED or during hospitalization. Methods: The American Headache Society (AHS) Special Interest Group for Inpatient and Emergency Care developed an online survey that was distributed to AHS members. Results: There were 106 survey respondents, 87 of whom completed all 13 questions. The most frequent choices for first-line ED migraine treatment in an otherwise healthy adult were dopamine antagonists (58.7%), non-steroidal anti-inflammatory drugs (NSAID) (49.0%), and IV hydration (48.1%). The most frequently selected second-line treatments were valproic acid, dihydroergotamine (DHE), and NSAIDs. Opioids were chosen by 1% for first line and 4.8% for second line. No respondents selected barbiturate containing medications for either treatment. The most frequently selected medications for initial treatment during inpatient hospitalization for migraine were DHE (64.5%), dopamine antagonists (61.3), and NSAID (37.6%). The most frequent adjunctive treatments were valproic acid and corticosteroids. Vomiting, medication overuse with opioids or barbiturates, and ED recidivism were the most frequently selected indications for inpatient treatment. The majority of respondents (71%) indicated they would taper or stop opioid medication as a part of migraine treatment in patients admitted for intractable migraine who were taking opioids for an unrelated indication such as low back pain. Commonly selected ancillary services included psychology (80.6%), physical therapy (64.5%), nutrition (50.5%), and psychiatry (46.2%). The majority of respondents (79.3%) indicated that outpatient follow-up should occur within 4 weeks of discharge from the hospital. Conclusions: Headache specialists indicated neuroleptics, NSAID and migraine-specific agents should be considered before opioids or barbiturates for both adults and children with migraine. There was consensus that worsening or refractory migraine treatment should not include the escalation of chronic opioids. Opinion suggested that opioid or barbiturate overuse is more likely to warrant inpatient treatment than triptan or NSAID overuse. Multidisciplinary care and close follow-up are important components of inpatient migraine treatment.
Authors and Affiliations
Carrie O. Dougherty, Michael J. Marmura, Zuhal Ergonul, I. V. Larry Charleston, Christina L. Szperka
Keywords
Related Articles
- EP ID EP349239
- DOI 10.9734/BJMMR/2014/9111
- Views 96
- Downloads 0
Health Promotion of Young University Students in Lebanon: Physical Activity Behavior and Cultural Barriers
The aim of the present study was to assess the prevalence of physical activity (PA) and exercise behaviors in young students and to propose an evidence-based exercise practice program for undergraduates in a university s...
Effects of Micronutrient Supplementation on Lipid Peroxidation and Enzymatic Antioxidant System in Blood of Human Immunodeficiency Virus (HIV)-infected Adults in Sokoto, Nigeria
Aims: To examine the effects of micronutrient supplementation on lipid peroxidation and enzymatic antioxidant system in 210 HIV-positive adult patients. Study Design: A randomized clinical trial was conducted comparing...
Use of Anatomical Undercut in Adhesive Retained Orbital Prosthesis: An Alternative to Osseointegration to Improve Retention and Reduce Margin Gap
Introduction: Poor retention, stability and margin gap due to excessive bone lose following surgery is one of the major problems of rehabilitation in orbital defect with adhesive retained orbital prosthesis. Presentatio...
Safety of Fasting in Patients with Type 1 Diabetes during Ramadan: A Prospective Study from Pakistan
Aims: To observe safety of fasting in patients with type 1 diabetes during Ramadan. Methods: A prospective, case control study was conducted in the Out-patient department of Baqai Institute of Diabetology and Endocrinol...
High magnitude of diabetes mellitus among Active Pulmonary Tuberculosis Patients in Ethiopia
Aim: The main aim of this study was to determine the prevalence of diabetes mellitus in patients with active pulmonary tuberculosis at the University of Gondar Teaching Referral Hospital, northwest Ethiopia. Study Design...