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Health Resource Utilization of the Emergency
Department Headache 'Repeater'
Morris Maizels, M.D.
Posted: February 2003  
Headache 2002; Vol. 42, No. 8

Objective:   To document the health resource utilization of patients who repeatedly use emergency department services for headache care.

Background:  Patients with headache who frequently use emergency department services may differ from patients with more typical, episodic migraine. Previous studies of health resource utilization have often failed to distinguish the high utilizer as a specific subset of the migraine population.

Patients and Methods:  Patients who made three or more visits for headache to an urgent care/emergency department (UC/ED) facility over a 6-month study period were identified and designated as “repeaters” for this study. Pharmacy profiles and appointment histories of 52 of the 54 repeaters whose records were available were reviewed for the 12 months prior to the study period.

Results:   Over the 6-month study period, 518 patients visited the UC/ED 1004 times for primary headache complaints. Fifty-four repeaters made 502 visits. In the 12 months prior to the study period, 52 of these repeaters made 1832 visits to the UCED or clinic that were headache related, and 1271 of all visits were to the UC/ED. An estimated 12-month cost for all visits was $183,760. Pharmacy rosters showed use of narcotics in 41 of the 52 patients, benzodiazepines in 30 patients, and butalbital products in 27 patients.

Conclusion:  Health resource utilization of emergency department headache repeaters is predominantly headache-related acute care. Associated medication overuse is frequently present. Efforts to improve care for patients with headache will benefit from distinguishing the high utilizer as a subset of the migraine population.