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Article

Trends in the Management of Headache Disorders in US Emergency Departments: Analysis of 2007–2018 National Hospital Ambulatory Medical Care Survey Data

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Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
2
Neurology Department, College of Medicine, University of Florida, Gainesville, FL 32611, USA
3
College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
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Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA
6
Health Science Center Libraries, University of Florida, Gainesville, FL 32611, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Antonio J. Carcas-Sansuán and Alberto M. Borobia Pérez
J. Clin. Med. 2022, 11(5), 1401; https://doi.org/10.3390/jcm11051401
Received: 30 November 2021 / Revised: 18 February 2022 / Accepted: 28 February 2022 / Published: 3 March 2022
(This article belongs to the Collection Practice and Research in Clinical Pharmacology)
We examined trends in management of headache disorders in United States (US) emergency department (ED) visits. We conducted a cross-sectional study using 2007–2018 National Hospital Ambulatory Medical Care Survey data. We included adult patient visits (≥18 years) with a primary ED discharge diagnosis of headache. We classified headache medications by pharmacological group: opioids, butalbital, ergot alkaloids/triptans, acetaminophen/nonsteroidal anti-inflammatory drugs (NSAIDs), antiemetics, diphenhydramine, corticosteroids, and intravenous fluids. To obtain reliable estimates, we aggregated data into three time periods: 2007–2010, 2011–2014, and 2015–2018. Using multivariable logistic regression, we examined medication, neuroimaging, and outpatient referral trends, separately. Among headache-related ED visits, opioid use decreased from 54.1% in 2007–2010 to 28.3% in 2015–2018 (Ptrend < 0.001). There were statistically significant increasing trends in acetaminophen/NSAIDs, diphenhydramine, and corticosteroids use (all Ptrend < 0.001). Changes in butalbital (6.4%), ergot alkaloid/triptan (4.7%), antiemetic (59.2% in 2015–2018), and neuroimaging (37.3%) use over time were insignificant. Headache-related ED visits with outpatient referral for follow-up increased slightly from 73.3% in 2007–2010 to 79.7% in 2015–2018 (Ptrend = 0.02). Reflecting evidence-based guideline recommendations for headache management, opioid use substantially decreased from 2007 to 2018 among US headache-related ED visits. Future studies are warranted to identify strategies to promote evidence-based treatment for headaches (e.g., sumatriptan, dexamethasone) and appropriate outpatient referral and reduce unnecessary neuroimaging orders in EDs. View Full-Text
Keywords: headache; primary headache; migraine; NHAMCS; ED visits; neuroimaging; opioid analgesic; triptan; antiemetic; trend headache; primary headache; migraine; NHAMCS; ED visits; neuroimaging; opioid analgesic; triptan; antiemetic; trend
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MDPI and ACS Style

Yang, S.; Orlova, Y.; Lipe, A.; Boren, M.; Hincapie-Castillo, J.M.; Park, H.; Chang, C.-Y.; Wilson, D.L.; Adkins, L.; Lo-Ciganic, W.-H. Trends in the Management of Headache Disorders in US Emergency Departments: Analysis of 2007–2018 National Hospital Ambulatory Medical Care Survey Data. J. Clin. Med. 2022, 11, 1401. https://doi.org/10.3390/jcm11051401

AMA Style

Yang S, Orlova Y, Lipe A, Boren M, Hincapie-Castillo JM, Park H, Chang C-Y, Wilson DL, Adkins L, Lo-Ciganic W-H. Trends in the Management of Headache Disorders in US Emergency Departments: Analysis of 2007–2018 National Hospital Ambulatory Medical Care Survey Data. Journal of Clinical Medicine. 2022; 11(5):1401. https://doi.org/10.3390/jcm11051401

Chicago/Turabian Style

Yang, Seonkyeong, Yulia Orlova, Abigale Lipe, Macy Boren, Juan M. Hincapie-Castillo, Haesuk Park, Ching-Yuan Chang, Debbie L. Wilson, Lauren Adkins, and Wei-Hsuan Lo-Ciganic. 2022. "Trends in the Management of Headache Disorders in US Emergency Departments: Analysis of 2007–2018 National Hospital Ambulatory Medical Care Survey Data" Journal of Clinical Medicine 11, no. 5: 1401. https://doi.org/10.3390/jcm11051401

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