Maintaining a High Level of Migraine Care in the ED Setting: Anne-Maree Kelly, MD


The director of the Joseph Epstein Center for Emergency Medicine Research discussed the complexities of diagnosing migraine in the emergency department and whether institutions should reevaluate their internal processes to do so. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"To increase the understanding [of migraine] is not quite as simple as neurologists and neurosurgeons think it is, because they’re only thinking in their box, rather than more broadly. That [our research] should help the dialogue about how we progress these things go forward.”

Headache disorders represent one of the most common neurological problems globally; however, little is known about the epidemiology of nontraumatic headache in patients presenting to emergency departments (ED). A multicenter, observational, cross-sectional study conducted over 1 calendar month in 2019 aimed to assess the epidemiology of these headaches further by focusing in on the clinical features, investigations, treatment, diagnosis, and outcomes. In total, 4536 patients from 67 hospitals in 10 countries were used in the analysis.

Following the study, lead author Anne-Maree Kelly, MD, and colleagues concluded that the diagnosis and management of headache in the ED is challenging, with more than 30 different diagnoses made throughout the evaluation. Similar to previous research, there was a wide variation in the use of neuroimaging, with computed tomography scan utilization ranging from 15.9% to 75.0% between countries.

Kelly, senior emergency physician, Western Health, and director, Joseph Epstein Center for Emergency Medicine Research, hopes these findings will spark conversation within the migraine space and between institutions. NeurologyLive® sat down with Kelly to help understand the most notable takeaways from the study, including whether these findings should prompt other EDs to conduct self-evaluations of their own.

Kelly AM, Kuan WS, Chu KH, et al. Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)–a multinational observational study. Headache. Published online November 2, 2021. doi:10.1111/head.14230
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