Evaluation of the therapeutic management of patients who visit the emergency department for treatment of acute migraine attack

Objectives: To analyze the therapeutic management of patients consulting in the emergency department to relieve an acute migraine attack to determine whether it complied with the recommendations of the French Headache Society. Methods: We conducted an observational multicenter cohort prospective study. The patients included were adults (age ≥ 18 years) consulting in the emergency department (Lariboisière or Bichat Hospital) for the management of acute migraine attacks of moderate to severe intensity. The data was collected from October 1, 2021, to January 31, 2023. The primary endpoint was the proportion of patients reporting complete pain relief two hours after first-line treatment in the emergency department. Descriptive and stratified analyses of the data collected were performed. A logistic regression model was fitted to assess the association between complete relief and predictor variables. Results: Our sample included 178 patients. The median age was 33 years. Most patients were female (75%). To treat acute migraine attacks, 139 (78%) patients received first-line combination therapy. In most cases, this combination therapy included acetaminophen, metoclopramide, and clorazepate dipotassium. Triptans were administered to two patients. Seventy (45%) patients reported complete pain relief two hours after first-line treatment in the emergency department. Multivariate logistic regression identified age category [34–44] years as significantly associated with a higher probability of complete relief (OR = 10.1, 95% CI = 3.10–39.5, p < 0.001). Conclusions: The French therapeutic recommendations for the relief of acute migraine attacks were not sufficiently applied in two emergency departments.