A Retrospective Study of Headache Treatment Between Rural and Urban Emergency Departments in South Dakota

Headaches are a common chief complaint in emergency departments (EDs), with rural patients facing unique challenges such as geographic isolation and limited access to care. This study aims to compare treatment efficacy for this top five ED chief complaint between rural and urban EDs.

Patients treated for headaches from 2020-2023 were identified using diagnosis codes and electronic health records. Treatment plans and patient demographics were abstracted from identified charts. EDs were categorized as rural (populations under 50,000) or urban.

A total of 13,375 patients were included (6,165 urban, 7,210 rural). Pain reduction was similar between urban (3.78) and rural EDs (3.61) (p = 0.094). Urban EDs had longer visit times (2.95 hours vs. 2.60 hours in rural EDs). Medication use varied: opioids were more frequently used in rural EDs (8.3% vs. 3.6%), while NSAIDs, acetaminophen, and prokinetics showed similar use across both settings. Demographics differed slightly, with a higher percentage of Native American patients in rural EDs (10% vs. 5.5% urban).

Treatment efficacy for headaches did not differ significantly between urban and rural EDs. Rural patients spent less time in the ED, likely due to lower patient volume, and opioid use was higher in rural locations.