3rd Annual Academic Symposium - Chuemee Thao

Purpose Emergency department (ED) physicians have two main goals in treating migraine headaches: (1) quickly diagnose life-threatening conditions that may be causing the headache, and (2) provide rapid and effective treatment. Based on the few studies available, those diagnosed with migraine in the ED often receive narcotics (opioids) rather than migraine-specific agents. This study was designed to uncover the differences in treatment based on insurance. Methods Study was a retrospective, cross-sectional study of the 2007-2009 National Hospital Ambulatory Care Survey (NHAMCS). Patients included were 18 years of age or older with primary diagnosis of one of the following from the International Classification of Diseases – 9th Revision Clinical Modification (ICD-9CM) codes: 346.0, 346.1, 346.2, 346.9. There were no exclusions in this study. A Pearson’s chi-square analysis was used to determine the associations between independent categorical variables to outcome variables. Variables that resulted in a p-value ≤ 0.05 were considered significant and multivariate regression was performed to assess independence of variables. Odds ratios and 95% confidence intervals were reported. Results/Conclusion 742 patients met the criteria for analysis. Primary analysis revealed an association between insurance type and narcotic prescription for migraine treatment (p-value=0.0007). Medicare was the only significant insurance type to affect narcotic prescription for migraine (3.20; 95% CI, 1.49-6.90). Secondary analysis revealed significant factors that contributed to narcotic prescription was being white (p-value=0.004) and non-Hispanic (p-value=0.007). Multivariate logistic regression revealed other races were less likely to receive narcotics compared to whites (0.45, 95% CI, 0.21-0.97), with no difference seen in ethnicity.