Evaluating the Use and Timing of Opioids for the Treatment of Migraine Headaches in the Emergency Department

Tornabene, Stephen V.; Deutsch, Reena; Davis, Daniel P.; Chan, Theodore C.; Vilke, Gary M.

doi:10.1016/j.jemermed.2007.07.068

« Previous Next »The Journal of Emergency Medicine
Volume 36, Issue 4 , Pages 333-337, May 2009

Evaluating the Use and Timing of Opioids for the Treatment of Migraine Headaches in the Emergency Department

Stephen V. Tornabene, MD
- Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, California
Reena Deutsch, PHD
- Department of Family and Preventive Medicine, University of California San Diego Medical Center, San Diego, California
Daniel P. Davis, MD
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California
Theodore C. Chan, MD
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California
Gary M. Vilke, MD
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California
- Reprint Address: Gary M. Vilke, md, Department of Emergency Medicine, UC San Diego Medical Center, 200 West Arbor Drive, Mailcode #8676, San Diego, CA 92103

Received 26 August 2006; received in revised form 9 July 2007; accepted 13 July 2007. published online 15 February 2008.

Abstract

The objective of this study was to evaluate the throughput times of patients administered opioids for the treatment of migraine headaches in the frequent emergency department (ED) visitor. A retrospective review of ED patient records was conducted. Repeat patients were significantly more likely to receive opioids as a treatment, receive multiple doses of opioids, and receive opioids as the initial pharmacological treatment compared to non-repeaters. Patients administered opioids, regardless of repeater status, had significantly longer ED stays; 142 min (95% confidence interval [CI] 124–160) vs. 111 min (95% CI 93–129), respectively, p = 0.015. Patients given multiple doses of opioids had significantly longer ED stays than patients given a single dose of an opioid; 191 min (95% CI 156–225) vs. 125 min (95% CI 101–149), respectively, p = 0.003. Delayed administration of opioids did not result in longer ED stays in those patients eventually treated with opioids. Administration of opioids for migraine headache may result in longer ED stays when compared with non-opioid migraine treatments. Judicious use of opioids as a treatment for migraine headaches is recommended.

Keywords: opioid, migraine, headache, emergency department, repeater