1. Half of patients visiting the emergency department for acute migraine could have been diagnosed earlier.

Evidence Rating Level: 2 (Good)

Headache is a common primary complaint for patients visiting an emergency room (ER), accounting for about 1–4% of all ER visits and for 8–14% of consultations at neurological ERs globally. The majority (75%) of these patients suffer from primary headache disorders, mainly migraine. Some patients experiencing migraines may have already experienced multiple attacks prior to their ER visit but were not diagnosed. Given the high prevalence (36%) of migraine without an aura in Switzerland, this study aimed to quantify the problem of missed migraine diagnosis prior to ER visits. This prospective observational study was conducted at the University Hospital of Bern, Switzerland from March 2019 to November 2021. Adults > 18 years who visited the ER with the primary complaint of acute headache were included. Out of 301 patients recruited, 137 were diagnosed with acute migraine attacks, of which 108 (79%) had previous migraine attacks (mean ±SD age = 40.6 ± 15.9, 74% female). Out of these 108 patients, only 54 (50%) were previously diagnosed with migraine. Overall, this study found that although the majority of patients visiting the ER for acute migraine attacks had experienced previous migraine attacks, only half of these patients had been diagnosed. These findings suggest that migraine is underdiagnosed in prehospital care and that timely diagnosis with prescription of a specific acute treatment may prevent unnecessary ER visits.

Click to read the study in PLOSONE

Image: PD

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