Emergency treatment of migraine

During the past few years, several surveys have highlighted the high prevalence of migraine amongst the general French population and the large healthcare burden associated with suboptimal treatment. Since it opened, the Centre d'Urgences Céphalées (EHC) has treated more than 55 000 patients, the majority of whom were suffering from migraine. Expert diagnosis of the type and causes of the headache, followed by immediate medication, allows patient stabilization. Detailed assessments can then determine the most appropriate treatment for each patient to improve outcomes and reduce the necessity for further emergency admissions. Triptans are generally recommended, and for those patients who currently have ineffective migraine control with one triptan, individual evaluation allows prescription of an alternative triptan which will better suit their needs. Follow-up is crucial to ensure that treatment remains optimal and that patient expectations are being met. Although a minority of patients with severe headache will continue to require repeated emergency treatment, more than 90% of patients seen at the EHC can be successfully managed with this combination of accurate diagnosis, effective treatment and individualized follow-up care.