Rapid Rx Quiz: Headache Medications

Mary L. Windle, PharmD


September 12, 2022

Conducting a cross-sectional study using 2007-2018 National Hospital Ambulatory Medical Care Survey data, researchers examined trends in management of headache disorders in US ED visits. Adult patients with a primary ED discharge diagnosis of headache were included. Headache medications were classified by these pharmacologic groups: opioids, ergot alkaloids/serotonin 5-hydroxytriptamine receptor agonists (ie, triptans), butalbital, acetaminophen/nonsteroidal anti-inflammatory drugs (NSAIDs), antiemetics, corticosteroids, diphenhydramine, and intravenous fluids.

Researchers aggregated data into three time periods, 2007-2010, 2011-2014, and 2015-2018, to obtain reliable estimates as well as examined medication, outpatient referral trends, and neuroimaging separately using multivariable logistic regression.

Opioid use decreased in ED visits for headache from 54.1% in 2007-2010 to 28.3% in 2015-2018. Insignificant changes in ergot alkaloid/triptan use were found (4.7%), despite evidence-based treatment guidelines to the contrary. Researchers also observed statistically significant increasing trends in diphenhydramine, acetaminophen/NSAIDs, and corticosteroids use as well as changes in butalbital (6.4%), antiemetic (59.2% in 2015-2018), and neuroimaging (37.3%) use that were insignificant over time. Overall, this represented a mostly diverging approach compared with evidence-based guideline recommendations for management of headaches.

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