Urgent Care Centers Less Likely to Follow American Headache Society Guidelines for Migraine

Patients who visit urgent care centers for acute migraine often do not receive the emergency treatment as recommended according to guidelines from the American Headache Society (AHS), according to study results published in Headache.

Urgent care centers are emerging as a preferred treatment location for patients with migraine, given the long wait times, bright lights, loud noises, and stress over cost of treatment associated with emergency departments (EDs), which can exacerbate migraine symptoms. Despite the growing popularity, there is limited evidence on how migraine is managed and treated in urgent care settings. The objective of this study was to examine trends in the management and treatment of migraine at urgent care centers and to determine whether medications administered on-site and prescribed on discharge were consistent with treatment guidelines from the AHS.

In this study, researchers performed a retrospective chart review of patients diagnosed with migraine at 2 urgent care locations within the New York University Langone Health System between 2015 and 2018. They collected data, including baseline patient demographics, prior history of headache and migraine, reasons patients chose to visit an urgent care center, medications used at the center and prescribed on discharge, and characteristics of patient outcomes after discharge.

Researchers revealed that 78 patients were diagnosed with migraine at the urgent care centers during the study period. Of these patients, 78.2% (n=61) had a self-reported or documented history of headache or migraine and 67.9% (n=53) had a specific documented history of migraine. Of the patients with a documented history of prior headache (n=34), 79.4% experienced ≤2 headache days per month, and 94.1% had episodic migraine. Nonsteroidal anti-inflammatory (NSAID) drugs and triptans were the most widely used abortive medications (39.3% and 37.7%, respectively) among patients with a history of headache or migraine, with 19.7% of those patients having indicated prior use of preventive migraine medications.

The most common reason cited by patients for coming to urgent care was ongoing migraine (53.8%), followed by ongoing headache (25.6%). No patients who visited the urgent care centers for a variation of head pain were referred for head imaging, and only 6.8% of patients received lab testing. Less than half (46.6%) of patients presenting with pain were given medication, with ketorolac injection the most common medication administered (70.6%). The majority (78.2%) of patients received some prescription during their urgent care visit, with 33.3% receiving a prescription for an NSAID and 25.6% receiving a prescription for a triptan. Of the 47 (60.3%) patients instructed to follow up with a neurologist upon discharge, only 19 (40.4%) patients followed up as directed.

This study had several limitations. First, generalizability was limited, given that the study was conducted in a single academic healthcare system. Second, the study was limited only to patients diagnosed with migraine as determined by urgent care physicians or patient report and may not meet criteria set forth by the International Classification of Headache Disorders. In addition, data were missing details on the history, frequency, and symptoms of headache among patients, and follow-up data may have been incomplete, as patients may have followed up with neurologists and headache specialists unaffiliated with the New York University Langone Health System after their visits to urgent care centers.

The study researchers concluded that patients with migraine who are visiting urgent care centers are often not receiving medications with the highest level of evidence for acute migraine management in an ED setting, according to the AHS, and that improvements in migraine management and treatment in the urgent care setting could reduce the economic burden of the disease and prevent more ED visits.

Reference
Minen MT, Zhou K, Miller L. A brief look at urgent care visits for migraine: the care received and ideas to guide migraine care in this proliferating medical setting [published online December 4, 2019]. Headache. doi:10.1111/head.13717