Nursing & Health Sciences Research Journal
Abstract
Introduction: Migraines account for approximately 1.2 million U.S. emergency department (ED) visits annually, yet fewer than 25% of individuals achieve sustained relief, underscoring the need for more effective, standardized care. The American Headache Society recommends first-line ED therapy with intravenous fluids, nonopioid analgesics, and antidopaminergic agents; if inadequate, escalation to triptans or dihydroergotamine is appropriate, with adjuncts such as magnesium or valproic acid. Opioids are discouraged due to limited efficacy and safety concerns. We evaluated the impact of implementing an evidence-based ED migraine pathway following provider education.
Methods: We conducted an observational pre-/post-intervention quality improvement project (January–April 2025), including 100 adult ED individuals with migraine (n = 50 pre-intervention; n = 50 post-intervention); pregnancy was an exclusion. In February 2025, the principal investigator delivered targeted education to ED providers. The primary outcome was the proportion receiving first-line evidence based therapy post-education. Secondary outcomes were opioid exposure, admissions without symptom resolution, and 30-day ED return visits.
Results: Use of evidence-based therapy increased from 74% (n = 37) pre-intervention to 88% (n = 44) post-intervention. Opioid prescribing decreased from 26% (n = 13) to 12% (n = 6). Admission rates declined from 12% (n = 6) to 6% (n = 3). No 30-day ED return visits occurred in either group.
Conclusion: Implementing an evidence-based migraine pathway, reinforced by focused provider education, improved adherence to guideline-concordant care, reduced opioid utilization, and lowered admissions. Future work will integrate the pathway into a standardized ED order set, assess sustainability and provider adherence over time, and evaluate downstream effects on inpatient prescribing and patient-centered outcomes.
Recommended Citation
Porben Guzman, L., Dittmar, E., Wolfel, T. J., Justiz, J. Y., Vargas, A., & Palma, S. (2025). Evaluation of migraine treatment in the emergency department. Nursing & Health Sciences Research Journal, 8(1), 155-163. https://doi.org/10.55481/2578-3750.1240
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