Characterization and prediction of emergency department use in chronic daily headache patients

Objective.-To examine the characteristics of chronic daily headache sufferers who use emergency departments (EDs) and identify factors predictive of ED visits. Background.-Several large clinical trials have found that a sizable subset of headache patients uses EDs frequently, although such visits should be preventable. Methods.-Participants in two large clinical trials provided baseline data on ED use, hospitalizations, disability, daily activities, and quality of life. Results.-Of the 785 patients included, 182 (23.2%) reported at least 1 ED visit over the past year. Most of these patients (82.9%) reported one to six visits; however, 4.4% reported >= 21 visits (mean 5.0; SD 8.5). The percentage of patients with overnight hospitalizations during the previous year was significantly greater in the ED user group than non-ED user group (17.6% vs 1.7%; P < .001), as was the number of visits to healthcare practitioners (median 24.3 vs 11.8; P < .001). Compared with non-ED users, a higher percentage of ED users reported severe disability on the Migraine Disability Assessment Scale (MIDAS) (85.7% vs 69.3%, P < .001) and indicated that their headache more negatively impacted mood and daily activities (all P < .05). ED users also had significantly higher depression scores and lower scores on all domains of the Short Form-36 (SF-36) (all P < .05). In a logistic regression model, patient age, neurologist visit, severe (vs not severe) rating on the MIDAS, Role Physical (SF-36), and prior overnight hospitalization were significant predictors of ED use (max-rescaled R-2 = 21.0%). Conclusions.-Patients seeking ED treatment for chronic daily headache are more severely affected and have more unmet medical needs than those who do not use the ED. Management strategies that help prevent frequent ED use might be possible.