The Variation in Migraine Management in Emergency Departments: Anne-Maree Kelly, MD


The director of the Joseph Epstein Center for Emergency Medicine Research provided context on the types of research needed to further evaluate and improve diagnosis and management of headache in emergency departments. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"What about the downstream impacts like cost or service delivery? For those things, we would again need some prospective studies, but also with a follow-up period because what we couldn’t collect was the things we missed. How many misdiagnoses do we make? How can we avoid that? How could we improve the sensitivity of our process?"

Headache disorders, one of the commonest neurological problems globally, vary greatly and have a wide range of possible causes; however, little is known about the epidemiology of nontraumatic headache in patients who present to an emergency department (ED). A multicenter, observational, cross-sectional study was conducted over 1 calendar month in 2019 to further evaluate the clinical features of these patients, as well as treatment, diagnosis, and outcome of their condition.

There were several notable findings, headlined by the fact that migraine can be challenging to diagnose in the ED setting, with more than 30 different diagnoses recorded during the analysis. Investigators also found considerable variation in CT rates by country, ranging from 15.9% in Romania to 75% in Israel (P <.001). Lastly, there were several different treatments used to treat these patients, the most common of which were paracetamol, followed by nonsteroidal anti-inflammatory drugs, including aspirin.

Lead author Anne-Maree Kelly, MD, senior emergency physician, Western Health, and director, Joseph Epstein Center for Emergency Medicine Research, and colleagues concluded that additional research is needed to understand this variation. She sat down with NeurologyLive® to discuss the questions that still need answering and the types of studies necessary that may help create guidelines that can be tailored to the differing capabilities of EDs across countries.

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. 2021;61(10):1539-1552. doi:10.1111/head.14230
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