Objective:

To assess the awareness and promote up-to-date evidence-based guidelines of acute migraine treatment among EM physicians.

Background:

Current guidelines recommend certain antiemetics and sumatriptan as first-line agents, dexamethasone for migraine recurrence, and avoidance of opioids and diphenhydramine. A 2022 study assessed trends in headache management in U.S. EDs and found the most prevalent combination therapy to be acetaminophen/NSAIDs, an antiemetic, and diphenhydramine. Triptans and corticosteroids were underutilized. No articles were found that surveyed EM physicians to examine their prescribing patterns or the reasons why they choose certain pharmacotherapies over others. It is presumed that the choices made by our surveyed EM physicians reflect the trends above.

Design/Methods:

13 residents and 2 staff physicians received a pre-test and a post-test questionnaire. After completing the pre-test, a brief lecture on current evidence-based guidelines for acute migraine treatment was presented. Then, participants completed the post-test which assessed their understanding of the lecture content. Data were entered into a spreadsheet and statistical analyses were performed.

Results:

Sumatriptan and opioids  were “rarely” or “never” used. Dexamethasone was utilized “sometimes.” NSAIDs/acetaminophen and antiemetics were “often” or “always” used. The number of correct answers nearly doubled after the lecture. The greatest number of correct answers was seen among PGY-1s and the least among staff physicians.

Conclusions:

Our findings are in line with the trends seen in the 2022 study. NSAIDs and antiemetics are the most commonly used, as is recommended, while sumatriptan and opioids are the least used. Though the scarce use of opioids should be maintained, EDs should utilize sumatriptan and dexamethasone more often and decrease the use of diphenhydramine. Education regarding evidence-based pharmacotherapy should be implemented to all EM physicians regardless of training level.