Pain treatment and relief among patients with primary headache subtypes in the ED

The aim of this study is to determine if emergency physicians treat headache subtypes differently and if this difference affects pain relief.

This was a prospective observational, institutional review board-approved study of adults undergoing treatment for a primary headache. Before the treatment and 60 minutes after, patients completed a 100-mm Visual Analog Scale (VAS) describing their pain. Patients also completed a headache diagnosis worksheet that differentiated headache type based on International Headache Society criteria. Treatments were recorded. Data were analyzed using descriptive statistics, 95% confidence intervals, analysis of variance, and chi(2) tests as appropriate.

A total of 184 patients were enrolled: 83 (45.1%) with migraine, 61 (33.2%) with migrainous, and 40 (21.7%) with tension-type headaches. There was no difference in the presenting VAS score or treatments of the 3 headache subtypes. The migraine group was most likely to receive any pain medication (78.31%), and the tension group the least likely to receive any pain medication (62.50%). A 50% decrease in VAS was achieved by only 32.5% of the patients. Sumatriptan, followed by droperidol, provided the greatest decrease in VAS scores. Oral and parenteral narcotics provided equivalent pain relief, with nonsteroidal anti-inflammatory drugs (NSAIDs) providing the least pain relief.

There was no difference in the treatments used or pain relief achieved between migraine, migrainous, and tension-type headaches. The differentiation of primary headache subtypes does not appear to be important to their treatment in the acute setting of the emergency department.