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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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Office
based headache clinic eases burden on Emergency
Departments |
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BY ALEC O’NEILL
Contributing Writer |
BOSTON — An office-based drop-in headache
clinic provides relief to both migraine sufferers and
over-burdened emergency departments, investigators
reported in a poster presentation on June 27 at the 50th
Annual Meeting of the American Headache Society.
“Migraine sufferers all too frequently seek emergency
department (ED) treatment when abortive therapies fail
at home,” wrote Dr. Peter J. McAllister and colleagues
from the Headache Center at Associated Neurologists of
Southern Connecticut in Fairfield, Conn. “Migraine care
in the ED setting is costly and often less than ideal.”
To help patients with migraine avoid an ED visit when
their at-home medications fail—at least during normal
working hours—the investigators established a drop-in
headache clinic in their eight-neurologist practice. The
clinic is staffed from 9 am to 4 pm weekdays, and
patients are quickly evaluated by a triage nurse
experienced in headache care. Patients are also seen by
a neurologist or physician assistant before discharge.
The authors presented before-and-after therapeutic
intervention data on the first 493 patients seen in the
clinic from September 2005 through August 2007. In all,
91% of the patients were women, 92% were of Caucasian
origin, and most patients were middle-aged (average age
47 years). (McAllister PJ et al. Implementation of an
Office-Based Drop-in Headache Clinic: Providing Quality,
Cost-Effective Care to Migraineurs. Abstract F56.)
Three-fourths of the patients (76%) had migraine without
aura, and 19% of all patients reported 15 or more
headache days per month. Of this group, about half (53%)
had sought ED care in the last 12 months, with 56%
having been to ED once, 31% twice, and 13% going three
or more times.
The average Migraine Disability Assessment Scale (MIDAS)
score was in the disabled range, at 46 (range 9–124).
The average wait time from headache onset to
presentation at the clinic was 104 hours (range 8–240
hours).
Nearly all patients (94%) received intravenous fluids,
84% received IV ketorolac (84%), 78% received a
subcutaneous tripan, and 52% received prochlorperazine.
Less frequent therapies included intravenous formulation
of metoclopromide (21%), dexamethasone (18%), valproate
(8%), dihydroergotamine (8%), and magnesium (4%).
Patient-rated pain on a 10-point visual analog scale was
8.5 (range 4–10) at clinic entry, and 1.5 (range 0–5) at
discharge. Patients spent an average of 42.5 minutes in
the clinic (range 19–240 minutes). The average charge
for services was $426, and the average payment was
$272.64.
The authors concluded that “an office-based nurse driven
drop-in headache clinic provided useful, individualized,
cost-effective treatment to a group of severely disabled
headache sufferers, most of whom were migraineurs,” and
noted that “patient satisfaction was high.” |
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