ED opioids for migraine, headache tied to more return visits, admissions

  • Am J Emerg Med

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Emergency department (ED) patients who received opioids for migraine or headache had a longer median ED length of stay (LOS), were more likely to return to the ED within 30 days, and had higher admission rates than patients who did not receive opioids.
  • The use of an opioid-free headache and migraine treatment algorithm was associated with a decrease in ED revisit rates, opioid administration, and opioid prescriptions provided at discharge.

Why this matters

  • Studies suggest the use of opioids in EDs to treat headache or migraine is increasing, even though American Academy of Neurology and American Headache Society guidelines recommend against the treatment.

Study design

  • 2953 patients with headache/migraine visited ED.
  • 1614 patients visited ED before opioid-free headache and migraine treatment algorithm implementation.
  • Funding: None.

Key results

  • Patients in the post- vs prealgorithm group had lower incidence of:
    • ED revisits within 30 days (6.3% vs 8.2%; P=.049),
    • overall ED revisits (9.2% vs 12.1%; P=.014),
    • opioid administration in the ED (5.2% vs 16.5%; P<.001 and>
    • opioid prescriptions at discharge (2.2% vs 7.2%; P<.001>
  • Patients who received opioid (n=335) had higher:
    • ED revisit rate within 30 days (15.2% vs 6.3%; P<.001>
    • admission rate (12.2% vs 3.2%; P<.001 and>
    • ED LOS (median, 182 vs 216 minutes; P<.001>

Limitations

  • Retrospective design.

Coauthored with Antara Ghosh, PhD