People with chronic migraines are heavy users of emergency room services, visiting such departments 42 per cent more than even other frequent users of the service, a new Ontario study shows.

Although their ranks were small, chronic migraine sufferers accounted for 3.5 per cent of total emergency room visits in the 1997 fiscal year in Ontario, said the study, by researchers at the Institute for Clinical Evaluative Sciences in Toronto.

Use of medical services by this particular group is so great the authors suggest further study should be undertaken to ensure they've been properly diagnosed.

"The enormous resource use of frequent migraineurs suggests that their clinical condition may not be typical migraine but a subgroup of migraine headaches known as transformed migraine, chronic daily headache, hemicrania continua or medication-overuse headache," wrote authors Dr. Ben Chan and Dr. Howard Ovens.

"Such a diagnosis is suggested because, in this study, the median frequent migraineur visited a physician (primary care, ED or specialist) almost once a week."

Previous studies have shown chronic recurring migraines can be very difficult to treat and can result from patients receiving too many pain-relieving medications, particularly narcotics. Treatment plans may include strict avoidance of narcotics and use of medications to prevent migraines from occurring.

The study, published Monday in the Annals of Emergency Medicine, is based on administrative data for most emergency departments and family physicians in Ontario for the period from April 1, 1997, to March 31, 1998. Unique identifiers on each file allowed the researchers to single out repeat users of services, although their names are shielded.

Of the 2.2 million emergency department visitors during that year, 6,839 were frequent users (12 or more visits a year). Among them, 478 were frequent migraine sufferers - most women, most aged 30 to 54.

Frequent migraine sufferers sought regular medical help both from an emergency room - and they tended to visit the same emergency department each time - and from their family doctor.

The average chronic migraine sufferer consulted a family doctor more than twice a month, in addition to frequent emergency department visits.

Loyalty to a single emergency department and a doctor may be helpful in treating these patients, Chan and Ovens argued. Since they see the same health-care workers over and over, it could be easier to ensure patients follow through on interventions designed to relieve their conditions.

One in seven of these patients were also followed up by a psychiatrist at least once in the year. Studies have suggested that patients with some psychiatric problems are at higher risk of developing migraines and that individuals who have migraines are more likely to suffer depression.

Reference Source 114

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