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Migraines & Other Headache Disorders: Emergency Department Treatment & Inpatient Admissions

According to a Statistical Brief recently issued by the federal Agency for Healthcare Quality and Research’s Healthcare Cost and Utilization Project, more than 3 million Americans visit the emergency department every year for treatment of headache disorders at a cost of approximately $408 million a year.

The agency collected data from all short term, non-federal hospitals in the United States to find out who was seeking treatment for headaches in hospitals and why.

About 35% of patients seeking treatment in the hospital setting were migraine sufferers. Most of the rest of the 3 million patients were seeking treatment for tension type headache, a variety of headache disorder that about 80% of people will deal with at some point in their lives. Patients seeking treatment for migraine and other headache disorders accounted for 2.4% of all annual emergency room visits.

Women are not only more likely to seek treatment in the emergency department for headaches and migraines, they are also more likely than men to be hospitalized for inpatient treatment of headaches and migraines. Nearly three out of four emergency department visits and inpatient admissions were for women. Since we already know more women than men live with migraine disease, these results aren’t especially surprising.

People in the 18 to 44 age group were most likely of all age groups to seek treatment for headache disorders in the emergency department setting. People in the 18 to 44 and 45 to 64 age groups were vastly more likely to be hospitalized for inpatient stays related to headache disorders than other age groups.

Perhaps somewhat surprisingly, there were differences in the number of people seeking treatment in the hospital setting for headache disorders based on geographical region. People in the Northeast were most likely to seek treatment for headaches and migraines in the emergency department, while people in the West were least likely. People in the South and Midwest ranked somewhere in the middle.

The data also showed a difference in emergency department utilization for headache disorders among urban and rural Americans. Emergency department visits were more frequent in rural areas and in low income areas. People in the lowest income communities were more than twice as likely to visit the emergency department as people in the wealthiest communities. This is likely attributable to the fact that rural and low income patients have vastly fewer treatment options than urban and wealthy patients. There was no difference between urban and rural dwellers in inpatient treatment for migraines and headaches, however.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Headaches in US Hospitals & Emergency Departments, 2008 | Headaches Send 3M People to Emergency Department

Comments

  • Expertscape
    6 years ago

    For those interested, you can find the top experts and institutions in migraine research and treatment here –

    http://www.expertscape.com/ex/migraine

  • Karen Marlowe
    8 years ago

    I have had migraines my entire life–or at least as long as I can remember… I have had excruciating pain that has lasted 2-3 days, throwing up, lying in a dark, quiet room… However, I have never been to the emergency room. Right now I am taking depakote and Sumavel. The combination is working well…

  • scrapbookcindy
    8 years ago

    Every time I’ve went to ER I have had bad experiences most of the time. The doctor’s would try what they call a cocktail and that wouldn’t work so they would ask me what should we do? How am I suppose to know I’m not the doctor.

  • Max Elbert Meier III
    8 years ago

    I suffer from atypical migraines that are caused by multiple triggers. Since I have underlying conditions which affect my migraines, it’s almost as if any triptan drug has a 50/50 chance at efficacy.

    I have cerebral palsy linked with both congenital and communicating hydrocephalus, and a suspected malfunctioning VPS (ventricular peritoneal shunt) with a confirmed catheter-to-valve disconnection of 2cm, with no history of revision. In addition, I also have congenital scoliosis and degradation and bulging (not to be confused with herniation) of the discs of L3-5. Due to this, I have been placed in a pain management program, excluding migraines.

    My problem is that until my neurologist can perform an LP to gather CSF pressure readings, neither the shunt problem nor my chronic migraine issues can be satisfactorily treated. As such, during a migraine episode, I will take my ‘rescue’ prescription of sub-lingual rizatriptan benzoate (MaxALT-MLT 15mg) at the first sign of an aura. Within the past two years, my emergency department visits have gone from roughly 3 annually to almost 2-3 times per week. CT scans show no significant changes, and have only been getting relief via either IV or IM Dilaudid injections. At first the ED staff was uncomfortable with my rather regular visits, however once I explained to the Department administrator that their facilities’ urgent care center was not properly equipped to control/relieve my migraine symptoms, another issue arose.

    When I go in now for treatment, the physicians automatically take the stance of “treat and street”. Granted a few have ran diagnostics, most review my chart prior to seeing me, have their nurse come in to administer pain meds, then simply check my level and discharge me. They could give a damn less about my opiate tolerance, let alone the constant level 8 migraine remaining even post-administration of medication. When I have a Level 8 migraine coupled with my chronic low-back pain (on average Level 6-7), I simply feel unable to function, and subsequently request multiple doses of pain control, as the average time of efficacy with 2mg IM Dilaudid (as an example) is usually 15-30 minutes.

    I am acutely aware of opioid tolerances, but when I am asked the question “What works best for your migraines (in terms of emergent pain control)?”, the answer causes them to immediately think I am no longer there for a migraine, but rather for a ‘fix’. Why? Because as odd as it may sound, Demerol has had the absolute best track-record of managing my most severe migraines when the triptans fail. About 99% of the physicians told this outright refuse the idea, and then the minimal amount of medications are used in an attempt to treat the migraine, with inadequate results (most often) during the visit. I’m not keen on having opiates coursing through my system due to tolerance issues, but what else can I do when all traditional means of treatment are expended? Therapies have not helped, as well as things like meditation, guided imagery, and sensory blocking.

    Talk about being frustrated…

  • Carol Porac
    8 years ago

    My doctor would like to put me on topamax as a prevention, can I have any feedback from anyone who has taen this drug.

  • Brenda Mitchel-Alcock
    8 years ago

    I am taking topomax right now. I did a couple of years ago and had to be weened off of it after it stopped working. So far it seems to be doing the trick. All i can do is what for menopause to finish up and hopefully, like my mom, i won’t have anymore attacks. They are getting fewer and farther apart. Thank God!

  • Cindy Hickmott Worley
    8 years ago

    Tried the topamax for 4 months without any significant improvement in the frequency of my headaches. It did seem to reduce the severity of the headaches at first but the longer I was on it I seemed to get less and less relief. I had the numbness and tingling in my hands and feet and it was interfering with my job so I went off it. I should also mention that I was recently diagnosed with fibromuscular dysplasia in both carotid arteries. The CT didn’t show any stenosis and my neurologist keeps telling me that the migraines are not caused from the issue with my carotids. My neurologist wants to try something else but wants me to get checked out thoroughly with my cardiologist first as I have an arrhythmia and premature heartbeats. He was concerned because some meds have a tendency to aggravate an arrhythmia. Tipi ax works great for some people, others not so great. Side affects are a big drawback with this drug.

  • Carol Porac
    8 years ago

    Thanks Nicole and Dawn for your input. It sedems that all of you have helped me make my decision no topamax. The side effects are not owrt it. There has to be somethin else out there.

  • Dawn Detrow Thomas
    8 years ago

    Carol, I wouldn’t do it. I was on it for 6mos and i didn’t know if i was coming or going.

  • Nicole Lescalleet Buhrman
    8 years ago

    Hi Carol! I was on Topamax for a while too. I hated it. As others have mentioned, I had a horrible metallic taste in my mouth and the tingling in my fingers and tongue. I also had problems with losing my hair… the plus side was, I didn’t have to shave very often. Good luck and I hope you find something that works!

  • Katie McNew
    8 years ago

    I’ve taken Topomax on and off for a few years now. When I was younger, I had loopy side effects, but now that I’m older, my only side effect at first was loss of appetite (and I didn’t complain about that!) It definitely does cut down on my migraines, and the severity of…though I still have to rescue with Imitrex.

  • Jen Porac Morra
    8 years ago

    Did you try acupuncture at all? I know that it is supposed to help for migraines. Also, Kevin has gone to the chiropractor for headaches and that has helped him tremendously too. Just a more holistic approach!

  • Danielle Munson Lapole
    8 years ago

    sorry Brayden is helping me type 😉 anyways it would not be my first choice as others have said! have you tried going to the Chiro? when I was pregnant and before I got horrible migranes and started going to the chiro and after about 3 or 4 visits I haven’t had a migrane since and I barely get headaches anymore!!

  • Danielle Munson Lapole
    8 years ago

    my best friend took it and it really

  • Carol Porac
    8 years ago

    YUCK!!! It seems that a lot of people seems to get the side affect of tingling in the hands and feet. Don’t want that metallic taste.

  • Erin Blickenstaff
    8 years ago

    I was on it and hated it. It affected my taste, things tasted really bland and metallic and it made my hands and feet tingle. If I didn’t take it at the exact time everyday I would get a headache and have to take another medication to relieve it.

  • Jerri Tate McNew
    8 years ago

    Never taken it but have read very mixed reviews!! Be careful!!

  • Stacie Hood
    8 years ago

    The botox shots helped me too! The only thing is that I had them about 8 months ago, and then last week he wanted to do them again. I was not excited about that, so for now he gave me some muscle relaxers to try out. My issue is that it starts in the back of my head and neck. But, the knots are going into my shoulders now. When he put the shots in, I would get a lightening bolt to my eye or ear. That showed him where the problems were. My doctor moved the needle around after putting it in. That made me feel alittle quizzy but didn’t hurt too bad. I felt a lot better afterwards. Maybe that is what I should keep doing? I just don’t know?

  • Donna Hill Conway
    8 years ago

    I had so much neck and shoulder tension……was injected and had no headaches for months……Haven’t been bothered by them like I use to be. Good Luck! I know how brutal they can be!

  • Carol Porac
    8 years ago

    I wondered if the botox would help. I am glad to know that you felt it helped.

  • Donna Hill Conway
    8 years ago

    I went through some migraines and had botox injections…..helped tremendously!

  • Stacie Hood
    8 years ago

    From what my Neurologist tells me, meds work differently for different people and it also depends on a person’s hormone levels, etc. That is why Topomax stopped working for me after working for several years. If I remember correctly, Topomax was a med that had to be increased over time to get use to it. And, if I missed a pill, it gave me side effects too. But, it did work better the more that I was on it.

  • Carol Porac
    8 years ago

    It does scare me Sue but many meds have been tried. Why do you say that is there something you know that you could share.

  • Carol Porac
    8 years ago

    Thanks Stacie and Donna. All of this feedback will help with my decision.

  • Sue Garner
    8 years ago

    If you have another option..try it first..

  • Donna Hill Conway
    8 years ago

    Angie was on it and it helped her migraines BUT….her hands and feet tingled and she had a very, very hard time functioning. She said she felt “stupid” like she knew what she wanted to say but couldn’t get the words out, if that makes any sense to you. She felt very sluggish and forgetful and it was hard for her to get through the work day so she went off of it. If you can get through it the first 4 months, I think many of the side effects go away or lessen.

  • Stacie Hood
    8 years ago

    About 7 years ago, I would have an average of 5 migraines a week. I took Topomax for a few years (it worked), but then I had to stop taking it when I got pregnant. I did like that type of meds because I had little side effects. For some reason after I had my son, it would not work for me anymore and the migraines increased with a bigger intensity. Now I am on 90 mg of Cymbalta and I still have about 2 migraines a week. But the side effects are not great at all. Dizziness when I bend over or when I increase my activity. I think that this is the best that I can ask for at this time. Because I also take a Fioreset pill when I still have one. It is a type of pain pill, but it works well in only about 10 minutes or so. Good Luck!!

  • Carol Porac
    8 years ago

    Thanks Julie that is good to know. I am not thrilled with the ifea just like you were with your daughter but if it will help I may give it a try. I was wondering how severe the side affects would be. Decrease in appetite I could handle. It just makes me nervous taking anything.

  • Carol Porac
    8 years ago

    Thank you Jennifer and Brenda. Your feedback is very helpful.

  • Julie Holter-Selin
    8 years ago

    Carol my daughter takes it for migraines. I wasn’t thrilled about it at first but it is the only thing that has helped. She started it about 4 months ago and hasn’t had a bad migraine since. She has really had a decrease in appetite though- has lost 10 pounds. A friend of mine who takes it says that eventually the appetite will come back.

  • Brenda Baker Burkett
    8 years ago

    I was put on Topamax last year & it has helped. I am also on Amerge in case I get one & it takes it away within seconds.

  • Jennifer Poindexter Horst
    8 years ago

    I have taken Topomax on and off for the past 3 years. I would be on it for several months and my headaches would get better but then I would get side effects from the medicine and then get weened off it. It would make my hands and feet tingle and just make me feel loopy after being on it for an extended period of time. I haven’t been it on for over a year because I’m not getting myobloc injections for my headaches but I did see some good results from the Topomax. Hope this helps a little 🙂

  • Jude Robinson
    8 years ago

    Low income patients are far less likely to have health insurance and are forced to use the ER for all health problems.

  • Louise M. Houle
    8 years ago

    It’s my menstrual migraines that send me to the ER every 2-3 months. I’m refractory to all preventatives (tried 18 in 10 years, including cocktails of several prophylactics) and have tried unsuccessfully many withdrawal protocols; therefore, I take 2 Triptans (Amerge) daily plus anti-inflammatories (Ketoprofen). When none of the abortive or rescue meds work and the pain has been at a 10 for 10-12 hours and I’m still vomiting – then I head for the ER. They usually take me immediately (Montreal, Quebec) but I often wait hours before actually getting the meds and subsequently some relief.

  • Krisshan Kant
    8 years ago

    get hold of Pran yantra or tesla purple energy plates india which is a natural pain management system for all your pain related emergencies, especially migraine, spondalities, back pain, etc.

  • Karen Stanley Haack
    8 years ago

    Sami probably went over 30 times…sometimes 2-3 times a week.

  • Marcy Sirrub
    8 years ago

    Prior to being put on preventative medications and being given a prescription for an excessive amount of abortive medications I was at the ER at least 3 times a month.

    Since I lost my health insurance and prescription coverage I’ve been tempted to resume trips back to the hospital for level 8 and above migraine attacks but without insurance I don’t want to be “treated and streeted” or given an excessive hospital bill that I could not pay on the best of months.

    When I applied for SSDI they pulled my medical records regarding migraine and in one year even with preventative and abortive medications I had gone to the ER in excess of 30 times.

  • Melissa Dwyer
    8 years ago

    I have spent the past year and half in the ER several times a month. The staff got to know me so very well.. I too, was admitted many of those visits, the rest they would treat me (or sometimes not treat at all) and send me home. The doctors in the ER after all this time have stopped treating me, telling me that this was not the solution, I have always understood this wasn’t the solution but I vomit up to 60 times a night with a migraine and after days of this during a single attack.. I get so dehydrated and the pain becomes unbearable that I am left with no choice. I am working with a doctor and is trying to stock me with things to keep me out of the ER, since their attitude and treatment have become so very unhelpful. I haven’t been to the hospital in over a month and for me that is a huge success! Thanks for the article!

  • Pam Fortney
    8 years ago

    I go to the ER at least 3 or 4 times a year when my rescue meds don’t work and when I can’t get ahold of my doctor’s office. These are the type that will put me down for a couple days.

  • Kate Benson
    8 years ago

    I used to go about every 2-3 months, but now I just use my rescue meds. About 2-3 times a year they don’t work, but I don’t want to be laid up for days like I was. I have to get an override for the amount of meds. I use as it is… They are Supposed to get better with age. I’m still waiting…

  • Mona Coia
    8 years ago

    Thanks Mary! I have hope now! I am 42 and they appear to be coming here and there but mainly at “that” time ~ I just recently found one of my triggers, peanut butter. Nothing over the counter works, I was out of work for 2 days (I only work 4days a week) and my job doesn’t understand the pain and torture. I went to urgent care and they no longer give imatrex shots so I settled for torodol which didn’t even faze it!

  • Laura E. Phillips
    8 years ago

    Unfortunately my migraines arrived with peri-menopuse and have stuck around through post-menopause.

  • Mary Frances Cooper
    8 years ago

    corn and corn products, chocolate, cheeses and caffine made them worst sometimes..and sometimes a coke would help…i dont envy you at all. are yours on the left or the right but never both sides at once?

  • Mary Frances Cooper
    8 years ago

    *anymore

  • Mary Frances Cooper
    8 years ago

    i had them so bad i would go to hospial for shot…imat+rix did not work for me… menopause helped.. i dont suffer any more-

  • Ella Parsons
    8 years ago

    I used to be in the ER at least once a Month for Migraine treatment. I have gotten significantly better lately, only seeking treatment every 4-6 months. I don’t know if my migraines are now less severe or if my rescue medication is just working better.

  • Jennifer Collins-Gonzalez
    8 years ago

    in Teri Robert’s book about migraines she put a form for your doctor to fill out in case you need to go to the ER you will have all the important info onyour meds and condition and will make that trip much easier to endure, the last time I waited more than 4 hours in the ER to get treatment!

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