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J Emerg Med. 2009 May;36(4):333-7. doi: 10.1016/j.jemermed.2007.07.068. Epub 2008 Feb 14.

Evaluating the use and timing of opioids for the treatment of migraine headaches in the emergency department.

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Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, California, USA.


The objective of this study was to evaluate the throughput times of patients administered opioids for the treatment of migraine headaches in the frequent emergency department (ED) visitor. A retrospective review of ED patient records was conducted. Repeat patients were significantly more likely to receive opioids as a treatment, receive multiple doses of opioids, and receive opioids as the initial pharmacological treatment compared to non-repeaters. Patients administered opioids, regardless of repeater status, had significantly longer ED stays; 142 min (95% confidence interval [CI] 124-160) vs. 111 min (95% CI 93-129), respectively, p = 0.015. Patients given multiple doses of opioids had significantly longer ED stays than patients given a single dose of an opioid; 191 min (95% CI 156-225) vs. 125 min (95% CI 101-149), respectively, p = 0.003. Delayed administration of opioids did not result in longer ED stays in those patients eventually treated with opioids. Administration of opioids for migraine headache may result in longer ED stays when compared with non-opioid migraine treatments. Judicious use of opioids as a treatment for migraine headaches is recommended.

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