A Brief Look at Urgent Care Visits for Migraine: The Care Received and Ideas to Guide Migraine Care in this Proliferating Medical Setting

Abstract

Objective There has been a rise in urgent care centers throughout the country over the past 10 years, leading to an increase in patients accessing medical care in these locations. These centers advertise an alternative to the Emergency Department (ED) for the evaluation and treatment of urgent medical conditions. The goal of this analysis was to examine the use of urgent care visits for migraine within 2 urgent care centers within a large academic medical system in New York City. We examined the trends in management and treatment of migraine in these urgent care settings, as well as prescriptions and instructions given to this patient population upon discharge. We paid particular attention to whether the medications administered and prescribed on discharge were those recommended by American Headache Society migraine management guidelines. Methods We conducted a retrospective chart review of patients with migraine diagnoses at 2 different urgent care locations within 1 large urban medical center. We determined baseline patient demographics, previous migraine characteristics, frequencies of reasons for urgent care visits as well as various medications administered, medications prescribed on discharge, and characteristics of patient outcomes post‐discharge. Results Of the 78 patients who visited urgent care with a migraine diagnosis, 20 (25.6%) had a known primary care provider within the urgent care centers' healthcare system. More than three‐fourths of all patients (78.2%) had a self‐reported history of either recurrent headache or migraine prior to the urgent care visit. Of those with a documented frequency of prior headaches, 94.1% (32/34) had episodic migraine and 79.4% (27/34) experienced at most 1‐2 headache days per month. Of those presenting to the urgent care during an episode of migraine, 12.3% (9/73) were given intravenous metoclopramide and none were given subcutaneous sumatriptan or intravenous prochlorperazine. Of those with reported nausea or vomiting with their migraine, 46.2% (18/39) received an anti‐emetic at the visit and 33.3% (13/39) were given an anti‐emetic prescription. Only 11.1% (6/54) of patients who did not have a record of previous triptan use were given a triptan prescription at the urgent care visit. Conclusions The majority of patients in our study who sought medical treatment for migraine in these 2 urgent care centers were not established patients within the urgent care centers' healthcare system. While 93.6% (73/78) of patients were experiencing current pain upon presentation to the urgent care centers, only 12.3% (9/73) received administration of the medications with the highest level of evidence by the American Headache Society (Level B) for acute migraine treatment in an ED. In addition, the majority of patients with a migraine history presenting to the urgent care setting were not given triptans or anti‐emetic prescriptions upon discharge from their urgent care visit. Having these migraine‐specific prescriptions may improve self‐treatment at home should a migraine attack recur.

An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review

“…The extracted papers rationalized non-adherence in different ways, the most consistent rationalization for opiate overuse being a lack of awareness of guidelines as supported by five of the extracted articles [17,18,21,25,27]. This phenomenon can rationalize the variation in prescription rates within a limited geographic area.…”

“…This included: 57% (n = 8) from the United States, 21% (n = three) from Australia and 7% (n = one) from Pakistan, France, and Canada. The study population with migraine ranged between 78 [18] and 2228 [1] subjects. Most migraineurs presenting to ED were young and female with average age ranges between 32.5 [18] and 44.5 [19] years and females consisting between 64% [27] and 85.9% of patients [19].…”

“…Whilst each study made comments on prescribing patterns observed, the medication classes which they primarily focused on were different. About half (57%) of the publications focused on the use of opiates [17,19,21,22,24,26,27], about a third (35%) sought to describe general prescribing patterns [1,18,20,23,25,29] without comparing specific classes of medications and only one study compared the use of migraine specific therapy to non-specific therapy [28].…”

“…Overall antiemetics as a general class were reported as the most used medication in 50% of studies [1,17,[19][20][21][22]28], followed by non-opioid analgesics at 28.5% [18,23,25,27]. Intravenous fluids were the most commonly were reported therapy in 14% [1,20] of studies and 21% studies did not include detailed descriptions of non-opiate prescription patterns [24,26,29].…”

Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study

“…This is not a criticism of care given in ED and UC settings, and reflects their important role in excluding secondary headache and providing immediate short-term relief. 36,37 Although we did not include ear, nose, and throat specialists or allergists as appropriate HCPs for migraine, we acknowledge that many of these specialists can, and do, diagnose and treat migraine appropriately. Given the overlap in symptoms associated with migraine and sinus problems, there may be a need for increased awareness of migraine among these specialists.…”