Determinants of Migraine Emergency Department Utilization in the Georgia Medicaid Population

Abstract

This study examined factors that may predispose migraine patients to emergency department (ED) visits. Headache is noted as the sixth most common reason for ED visits. Previous studies found that migraine headache patients may repeatedly use ED services for headache care. An understanding of the profile of patients who are at high risk of using the ED is important so that interventions to reduce ED use for nonurgent care can be targeted to those that are affected the most. Retrospective analysis of medical and prescription claims data was performed. Patients who had at least 1 migraine medical claim (ICD-9 of 346.xx) or 1 prescription claim of a triptan or ergot medication between January 2002 and December 2005, and were continuously eligible for at least 6 months before and 12 months after the date of the first migraine medical or prescription claim (index date) were included in the analysis. A total of 43,791 migraine patients met the inclusion criteria. Mean age was 31 years (SD = 17). About 77% were females and 56% were whites. About 7% patients used a butalbital medication and 28% used a narcotic medication 6 months before index date. About 3% (n = 1211) patients had at least 1 migraine ED visit during the 12 months after index date. Female, non-white patients or patients residing in counties that had fewer general practice physicians or more hospitals were significantly more likely to use the ED for migraine. Prior butalbital use had no effect on ED use, but prior narcotic medication use significantly increased the risk of ED visit. Patient demographics and health care resource availability significantly affected the likelihood of ED use of diagnosed migraine patients. Additional research is needed for the undiagnosed migraine population to inform the development of interventions to reduce ED utilization for migraines.