Timely Diagnosis of Migraine May Prevent Future Emergency Room Visits

About half of patients who visit the emergency room (ER) for acute migraine attacks could have received a diagnosis of migraine earlier, according to study findings published in the journal PLOS ONE.

The majority of patients who present to the ER with complaints of headaches experience primary headaches, including migraine, while about a quarter of these patients have secondary headaches. Due to the possibility that many of the patients presenting with migraine may have had migraines in the past without diagnosis and proper treatment, researchers in this study aimed to analyze the proportion of missed prior diagnosis and treatment of migraine in patients presenting to the ER.

For the prospective observational study, researchers included participants older than age 18 who presented to the ER at the University Hospital of Bern, Switzerland with a chief complaint of headache from March 2019 through November 2021. The primary outcome was the number of patients that had met the diagnostic criteria for migraine prior to their visit to the ER but were never diagnosed. Each patient was assessed through a semi-structured questionnaire used in routine treatment by an ER physician, which identified criteria for migraine diagnosis as well as factors that may indicate secondary headache, such as fever or confusion.

Patients who met the diagnostic criteria for migraine in the current ER visit were then grouped based on whether they had previous headaches fulfilling the criteria for migraine or not. Patients with previous migraines were then characterized further into those who had received a prior diagnosis of migraine and those who had not.

Of the 301 patients recruited, 196 were diagnosed with primary headache as opposed to secondary headache, with 137 diagnosed with acute migraine attack. Of the patients with migraine on this visit, 29 patients were experiencing their first migraine episode and 108 (mean age, 40.6; women, 74%) had experienced multiple migraines in the past, though only 54 of these patients were previously diagnosed with migraine.

With migraine attacks ranking high globally as a cause of disability, a timely diagnosis of migraine could provide patients earlier access to proper treatment and decrease the burden the condition has on patient quality of life. Moreover, it could decrease the financial burden that the loss of productivity places on patients, employers, and the health care industry.

This study is limited by the reliance on patient reporting of previous headaches in the ER, introducing possible recall bias, the lack of assessment of triptans prescriptions in patients without a diagnosis of migraine, and the likelihood of patients with headache being missed in the single ER included in the study.

“The timely diagnose of migraine and the prescribing of a specific acute treatment (triptans) have the potential to prevent unnecessary ER visits and thus substantially reduce healthcare costs,” the researchers concluded.