Dados do Trabalho

Título

Improving Emergency Department Headache Treatment: the Virtual Headache Training Program (VHTP)

Resumo

Introduction: Headache is among the most common causes of visits to the Emergency Department (ED), and migraine is the most common identifiable diagnosis in this context. The diagnosis of migraine is clinical, and neuroimaging should not be performed routinely unless an alarm sign is identified in the history or physical examination. Currently, the first-line treatment of acute migraine attacks should be performed with analgesics, non-steroid anti-inflammatory drugs, triptans, and antidopaminergic medications. Second-line treatment includes corticoids, magnesium, and nerve blocks. Opioids should be avoided for the treatment of migraine attacks2. Despite these recommendations, we identified a high use of opioids and a high rate of neuroimaging exams in the emergency department of a tertiary hospital in Brazil.

Objective: To evaluate the impact of a virtual headache training program (VHTP) for healthcare providers at the ED of a tertiary hospital in improving headache treatment.

Method: We evaluated preliminary data including all visits to the ED with the final diagnosis of migraine (CID G43) and unspecified headache (CID R51). The intervention consisted of an asynchronous virtual training program of 90 minutes, aimed to review the clinical presentation of the primary headaches, the alarm signs for secondary headaches, and an evidence-based treatment protocol for primary headaches. Data were collected for 14 weeks before and 12 weeks after intervention. The primary endpoint was the reduction in the rate of opioids prescription. Secondary endpoints were the reduction in neuroimaging examens in the ED, reduction of inpatient admission rate, and duration of inpatient treatment.

Results: we included 87 headache visits in the pre-VHTP group, and 96 in the post-VHTP group. The opioid prescription for headache patients was reduced in 75.1% (p = 0.005). There was no significant difference of the secondary outcomes. Neuroimaging was performed for 55.4% vs 41.8% (p = 0.16), mean length of ED visit was 249.3 vs 167.3 minutes (p = 0.23), inpatient admission rate was 5.5% vs 0.8% (p = 0.08) and length of inpatient admission was 2 vs 1 day (p = 0.32).

Conclusion: The Virtual Headache Training Program successfully improved headache treatment, reducing the opioid prescription by 75.1%.

Limitations: This is a single-center retrospective study with preliminary data from a small number of cases and a short period of observation.

Palavras Chave

Headache, Migraine, Opioids, Emergency, Education