Reflecting evidence-based guideline proposals for relieving headache, the usage of opioid analgesics has considerably decreased from 2007 to 2018 in United States (US) headache-associated emergency department (ED) visits, as elucidated from a recent cross-sectional study published in the Journal of Clinical Medicine. Furthermore, the use of non-opioid analgesic and outpatient referrals for follow-up raised considerably, while ergot alkaloid/triptan usage and visits with neuroimaging orders were found to remain stable.

Researchers aimed to assess the trends in managing headache problems in ED visits. Utilizing data from National Hospital Ambulatory Medical Care Survey from 2007 to 2018, this study was carried out. Adult patients (≥eighteen years) diagnosed with headache were incorporated. Various headache medicines were grouped into pharmacological categories, including intravenous fluids, opioids, corticosteroids, diphenhydramine, antiemetics, butalbital, acetaminophen/NSAIDs, and ergot alkaloids/triptans.

The data was combined into 3 distinct time periods: (a) 2007-2010, (b) 2011-2014, and (c) 2015-2018 in order to procure accurate estimations. Medication, neuroimaging, and outpatient referrals were assessed utilizing multivariable logistic regression. Opioid usage dropped from 54.1% in 2007-2010 to 28.3% in 2015-2018 among ED visits for headaches.

There were substantial rising trends in the use of corticosteroids, diphenhydramine, and acetaminophen/NSAIDs. The usage of neuroimaging (37.3%), antiemetics (59.2% in 2015–2018), ergot alkaloid/triptan (4.7%), and butalbital (6.4%) altered insignificantly over time. Outpatient referrals for follow-up for headache-related ED visits elevated slightly from 73.3% in 2007-2010 to 79.7% in 2015–2018.

Future research is important to determine how to eliminate unnecessary neuroimaging orders in EDs, promote evidence-based headache medications (such as dexamethasone and sumatriptan), and redirect patients to appropriate outpatient care.