Objective: To evaluate the characteristics of patients who use an emergency department (ED) repeatedly for headache care.
Methods: All visits for primary headache disorders to an ED over 6 months were tallied. Patients with 3 or more visits were classified as "repeaters". Pharmacy profiles and appointment histories of repeaters for the 12 months preceding the first visit were reviewed.
Results: During the study period, 518 patients made 1004 visits to the ED for primary headache complaints: 54 (10%) made 3 or more visits (total 502 or 50% of total; mean 9.3, range 3-50). Records of the previous 12 months were available for 52 of the 54 "repeaters". These 52 patients made 1832 visits to the facility for any reason (mean 35.2, range 0-178); 1458 (79.6%) were headache-related (mean 28, range 0-91) and 89.4% of all visits were
for acute care. Pharmacy rosters showed 41 (79%) patients had high narcotics use (annual mean (s.d.)=612 (670 tablets), 30 (58%) patients had high benzodiazepine use (annual mean (s.d.)=500 (486) tablets), and 27 (52%) patients had high butalbital use (annual mean (s.d.)=395 (590) tablets). Average daily use of all symptomatic medications combined was 3.9 (3.2) doses/day.
Conclusion: Patients who repeatedly present to an ED for headache commonly have associated medication overuse, which is refractory to migraine-specific therapy. Health resource utilization is predominantly for acute care. Treatment approaches designed for migraine will not address the needs of this population: the important comorbidities of chronic pain and psychiatric disease must be addressed with appropriate resources.