Rural Patients Utilize ED for Migraine at Higher Rates


These populations are also more likely to receive opioid analgesic therapies.

Emergency department (ED) utilization for migraine-related treatment is higher in rural populations, according to a poster presented at the American Society of Health-System Pharmacists 2023 Midyear Clinical Meeting and Exhibition.1 Although migraine is the fifth most common reason for an emergency department visit, these visits may result in suboptimal care compared to outpatient primary or specialty care.

In a cross-sectional, epidemiologic study, researchers evaluated data associated with ED visits for migraine in 2019. The primary outcome was crude and age-adjusted rate of migraine ED visits per 10,000 population; secondary outcomes included medication utilization, imaging, and total charges associated with the ED visit. Subgroup analyses divided data by chronic and acute migraine, as well as Appalachian and non-Appalachian residence.

In total, 810,387 migraine-related ED encounters were identified, 22.6% of which were classified as for a patient living in a rural residence. In both rural and nonrural populations, patients were predominantly white and predominantly women (median age, 37 years).

Rural populations were associated with significantly higher crude rates of ED utilization for migraine compared with nonrural populations (39.8 vs 22.2 per 10,000 population, respectively). Age-adjusted rates of ED utilization were also significantly higher in rural populations (41.8 vs 23.4 per 10,000 population). A subgroup of Kentucky Appalachian patients had the highest crude and age-adjusted rates of ED utilization (44.9 and 47.4).

The use of opioid analgesics was more common with ED encounters in rural areas (14.6% vs 8%) and compared with a national rural cohort, patients in the Appalachian subgroup had significantly higher opioid utilization (19.8%). Computed tomography imaging studies were also performed less frequently in these rural settings (21.4% vs 23.4%), and mean total charges associated with ED visits were higher for non-rural patients ($5324 vs $3016).

“ED utilization for migraine is more frequent in rural populations, suggesting this may be an important social determinant of health outcome for patients with migraine,” the investigators concluded. “Further research should be directed at the creation of effective interventions to address the needs of rural populations, such as increasing access to abortive and prophylactic migraine outpatient therapies.”

1. Rhudy CN, Schadler A, Huffmyer M. Rural disparities in emergency department utilization for migraine care. Presented at: American Society of Health-System Pharmacists 2023 Midyear Clinical Meeting and Exhibition; December 3-7, 2023; Anaheim, CA.
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