Temporal distribution of emergency room visits in patients with migraine and other headaches

ABSTRACT

Background: Headache is a leading reason for presentation to the emergency department (ED) with migraine being the most frequently headache. To ensure the adequate staffing of healthcare providers during peak times of headache visits, we analyzed the temporal distribution of emergency department visits in patients presenting with headache and/or migraine.

Research design and methods: The authors conducted an ecological study, including all consecutive visits to the ED for headache. Patients were classified according to the IHS Classification. We analyzed circadian, circaseptan and circannual patterns for number of visits, comparing migraine patients with other headache patients.

Results: There were 2132 ED visits for headache, including primary headache in 1367 (64.1%) cases; migraine in 963 (45.2%); secondary headache in 404 (18.9%); and unspecified headache in 366 (17.1%). The circadian pattern showed peaks around 11:00–13:00 and 17:00–19:00, with visits during the night shift 45% less frequent (p < 0.001). The circaseptan pattern showed a peak on Monday-Tuesday and a low point on Sunday (p < 0.007). The circannual pattern peaked in March and decreased in June.

Conclusions: ED visits for headache showed specific circadian, circaseptan and circannual variations. No differences were found in these patterns when comparing migraine patients to other headache patients.

KEYWORDS:

• Headache disorders
• primary
• emergency service
• hospital
• chronobiology disorders
• circadian rhythm
• chronobiology phenomena

Supplementary material

Supplemental data for this article can be accessed here.

Article highlights

• Emergency department (ED) visits for headache follow specific circadian, circaseptan and circannual patterns.

• The timing of presentation to the ED with headache does not align with the previously described timing of headache onset.

• Migraine patients presented in similar patterns to other headache patients.

• The daily peak of headache visits occurred midday, between 11:00-13:00 and between 17:00-19:00.

• Patients visited the ED for headache more frequently on weekdays than over the weekend.

• The circannual pattern exhibited a decrease in visits for headache during the spring and an increase in visits during the fall.

Acknowledgments

The authors would like to thank the emergency department, the neurology department and the participants of the study.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethical approval

Ethics approval and consent to participate:

An ethics review board approved the study (CP14/425-E).

Consent for publication: Due to the retrospective nature of the study and the anonymity of the analyzed data, individual consent was not obtained.