Presenting patterns and pharmacological treatment of migraine in the ED

Mr James Hughes1, Dr Emily Shao2, Dr Rob Eley3

1Princess Alexandra Hospital, Brisbane, Australia, 2Royal Brisbane and Womens Hospital, Brisbane, Australia, 3Facility of Medicine, University of Queensland, Brisbane, Australia

BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine and to identify the medications used in treating this condition.

METHODS: This study is a retrospective database interrogation of clinical records, used to

collect quantitative data on patient demographics and medication prescriptions in the ED.

RESULTS: A total of 2 228 patients were identified as being treated for migraine over a 10-

Year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females (71%) more commonly presented to the ED with migraine than males. The migraine population was significantly younger (M=37.05, SD=13.23) than the whole ED population (M=46.17, SD=20.50) (P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and IV fluids with phenothiazine additives were commonly used. Over 20% of patients received oral or parental opiates (42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used.

CONCLUSION: Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a significant variation from published guidelines.


Mr Hughes has worked in some of the busiest emergency departments in Queensland. He currently is a Clinical Nurse Consultant at the Princess Alexandra Hospital in Brisbane and is completing his PhD in factors that influence pain care in the emergency department.