Chronic migraineurs: an important subgroup of patients who visit emergency departments frequently

Study Objective — We examine whether patients with frequent migraines represent a distinct subgroup of patients who visit emergency departments (EDs) frequently.

Methods — This population-based, cross-sectional study used fiscal year 1998 physician billing data from Ontario, Canada. "Frequent ED visitors" were individuals with at least 12 ED visits per year and were classified as either "frequent migraineurs" (> or =50% of ED visits for migraine) and "other frequent ED visitors."

Results — There were 2,158,291 ED visitors, of whom 6,839 were frequent ED visitors. These individuals accounted for 3.5% of all ED visits. Among frequent ED visitors, 478 were frequent migraineurs. The proportion of patients who were female was 79% among frequent migraineurs, 53% among other frequent ED visitors, and 50% among patients who were not frequent ED visitors. The proportions between ages 30 and 54 years for these 3 groups were 79%, 43%, and 31%, respectively. Average annual visits to EDs were 26, 18, and 1.7, respectively, and average visits to family physicians were 40, 20, and 5.9, respectively. Despite heavy healthcare use, frequent migraineurs sought 83% of their ED care from their most frequently visited ED and 71% of their primary care from their main family physician.

Conclusion — Frequent migraineurs are predominantly women aged 30 to 54 years and with a particularly intense use of healthcare services. Management strategies may require targeted interventions for these individuals. Because these patients seek most of their care from 1 main ED and 1 principal primary care physician, coordination of care may be easier than expected.