Migraines a major cause of frequent emergency department visits

Many patients who make frequent repeat visits to emergency departments (EDs) are suffering from migraines, a new study from the Institute for Clinical Evaluative Sciences (ICES) has found.

Study authors Dr. Ben Chan and Dr. Howard Ovens found that there were nearly 7,000 patients in Ontario who visited an ED at least once a month on average in fiscal year 1998. Of this group, 7% were coming to the ED for repeat migraine headaches. The large majority (80%) of these frequent migraine patients were middle-aged women. These patients also had heavy use of other health services such as family doctors and specialists. In total, they saw a doctor more than once a week on average.

Previous studies have shown that chronic recurring migraines can be very difficult for physicians to treat, and often result from patients receiving too many pain-relieving medications, particularly narcotics. Treatment plans may include strict avoidance of narcotics and use of medications to prevent migraines from occurring.

Dr. Chan, a senior scientist at ICES, believes that one of the keys to better management of these migraine patients is improved coordination between the ED and the family doctor. “We need to create management plans that the ED, family physician and patient can agree on, and stick to those plans. If these patients need to be weaned off their pain medications, for example, then that has to be carefully coordinated between all care providers. Such coordination will require a lot of work up front, but it may be better for patients in the long run.”

Interestingly, the study found that patients sought most of their care from one single ED and one single family doctor; in other words, they did not tend to ‘shop around’ to many different healthcare providers for treatment. “Because these patients go to mostly one family doctor and one ED, we have a real opportunity to coordinate their care,” said Dr. Chan.

The study, “Chronic migraineurs: an important subgroup of patients who visit emergency departments frequently”, appears in the February 2004 issue of the Annals of Emergency Medicine.

ICES is an independent, non-profit corporation that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by governments, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Argles
• Media Relations Officer, ICES
• (416) 480-4055 ext. 3602 or cell (416) 432-8143