Characteristics of patients presenting to the emergency department with headache

Study objectives: To better understand headache patients presenting to the emergency department (ED), we attempt to determine the characteristics of patients presenting with headache to the ED with respect to current prescription medication use. Methods: This was a prospective, observational, anonymous survey done as a pilot study in a university ED. A continuous sample of patients older than 12 years and presenting with headache were enrolled during a 6-month period. Patients were evaluated for use of prescription medications for headaches, previous headache diagnosis, age, income, number of ED visits, race, sex, education, insurance, primary care provider, headache specialist provider, employment, number of ED visits for headache, and Migraine Disability Assessment (MIDAS) score (previously validated headache disability score). Statistical analyses were performed with relative risk with 95% confidence intervals (CIs) calculated. The MIDAS score was evaluated for significance with a t test; P values were determined. Results: Ninety-nine patients were enrolled. Patients were more likely to be taking a prescription headache medication if they used a headache specialist (relative risk 1.9, 95% CI 1.4 to 2.5), if they had medical insurance (relative risk 2.7, 95% CI 1.1 to 7.5), or if they were in the upper income quartile of our cohort (relative risk 1.5, 95% CI 1.1 to 1.9). MIDAS scores were not found to be different between the patients with and without prescriptions (P=.09). Conclusion: Patients with headaches and receiving prescription medications were more likely to have a headache specialist, to be medically insured, and to have a higher income. This study illustrates the disparity of care for lower-income uninsured headache patients and identifies an area for further consideration in treatment of ED patients.