The burden of migraine on acute and emergency services in a London teaching hospital

There is a lack of data on the burden of primary headache disorders such as migraine on emergency services. Existing data relies on a coding of "headache", which encompasses both primary and secondary headache of all causes; for example, subarachnoid haemorrhage. Guy's and St Thomas' NHS Trust in London is one of the UK's busiest emergency departments with 150,000 attendances per year. Our aim was to assess the healthcare resource utilisation of primary headaches, in particular migraine, in acute medical services.

We conducted an audit of all adult presentations to the emergency department of Guy's and St Thomas' Hospitals which were coded as "headache" over the first 6 months of 2018. We reviewed the initial diagnosis at presentation and also at discharge, investigations and outcome.

Of 78,273 attendances to the emergency department, there were 976 presentations to the emergency department with "headache" as their primary complaint. "Migraine" was the most frequent of all diagnoses, accounting for 30% of all headache presentations and 25% of headache admissions. We calculated the cost of admitting and investigating migraine as £131,250 over the 6-month period.

Emergency admissions for migraine represent an avoidable cost and burden for both the hospital and the migraineur. This data informs us about the need to develop better care pathways for migraine in the community and to improve headache education for physicians and patients.