Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review

Version 1 : Received: 29 December 2020 / Approved: 30 December 2020 / Online: 30 December 2020 (07:55:04 CET)

How to cite: Lim, J.H.; Karimi, L.; Wijeratne, T. An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review. Preprints 2020, 2020120745 (doi: 10.20944/preprints202012.0745.v1). Lim, J.H.; Karimi, L.; Wijeratne, T. An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review. Preprints 2020, 2020120745 (doi: 10.20944/preprints202012.0745.v1).

Abstract

Migraine is one of the leading causes of disability worldwide [1,2]and patients with acute migraine frequently present to emergency departments (ED)[3]. The current literature suggests that ED treatment of migraine headache varies across institutions [4-7]. Considering this, we conducted a scoping review to summarize trends in medication prescribing patterns for acute migraine treatment in the ED setting. Trends were evaluated for factors influencing treatment choices, with particular attention placed on opioids and migraine specific therapy. This scoping review was based on the Arksey and O'Malley methodological framework[8]and included studies published between 1 January 2000 until 31 May 2020. 14 publications met the inclusion criteria. The most common classes of medication prescribed were often anti-emetics or Non-steroidal anti-inflammatory drugs (NSAID), but rates varied between studies. There was a concerning trend towards an underutilization of triptans and overutilization of opiates. The use of specific clinical goals of treatment (e.g. two-hour pain free freedom response) was also not evident. Additionally, 88% (n=8) of the 9 studies commenting on adherence to hospital or evidence-based guidelines stated that practices were non-adherent. Overall, the reviewed literature reveals treatment practices for acute migraine in the ED are heterogeneous and deviate from established international recommendations.

Subject Areas

Migraine; acute care; emergency department; analgesic; triptan; opioid and NSAID

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