Evidence suggests that many people with migraine visit the emergency department (ED) due to disabling acute or episodic attacks. “Unfortunately, the ED is not a good place for these patients,” explains Mia T. Minen, MD, MPH. “Migraine medications work best when given early, yet EDs often have long wait times. Also, EDs are often loud and bright, conditions not conducive to people with migraine who may have photophobia and/or phonophobia.” Urgent care centers offer an alternative to EDs, usually with shorter wait times and extended hours.
For a study published in Headache, Dr. Minen and colleagues examined the use of urgent care visits for migraine, focusing on trends in management and treatment of migraine in this setting, as well as prescriptions and instructions given to this patient population upon discharge. The study team reviewed the charts of patients with migraine diagnoses at urgent care locations, determining baseline patient demographics, previous migraine characteristics, frequencies of reasons for urgent care visits, various medications administered, medications prescribed on discharge, and characteristics of patient outcomes post-discharge.
Nearly 80% of patients had a self-reported history of recurrent headache or migraine before their urgent care visit. Among those with a documented frequency of prior headaches, 94% had episodic migraine and 79% experienced 1-2 headache days per month at most. Intravenous metoclopramide—one of the three medications with the highest level of evidence by the American Headache Society (AHS) for acute migraine treatment in the ED —was administered to only 12% of those who presented to urgent care while currently experiencing pain (94%). Neither of the other two medications with the highest evidence— subcutaneous sumatriptan or intravenous prochlorperazine—were administered. Among patients with reported nausea or vomiting with migraine, 46% received an anti-emetic during their visit and 33% received a prescription for one. A triptan prescription was given to only 11% of those who did not have a record of previous triptan use.
“We believe increased education about the AHS guidelines for migraine management in the ED might be transferable and useful for urgent care providers,” says Dr. Minen. “These medications should probably be included within the urgent care pharmacy and tried first when there are no contraindications.”