RESEARCH – April 2017

Emergency pre-hospital care and profile of patients treated for migraine

Authors: Sirli Saar, Siim Rinken, Merli Mändul, Mark Braschinsky

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Background and aim. Migraine is the most common and socio-economically costly neurological disease. It is a debilitating disorder. The main aim of this study was to review how two of the largest ambulance service providers in Estonia manage migraine in the pre-hospital setting. The second aim was to obtain an overview of the patients requiring ambulance services due to headache.

Methods. This is a retrospective cohort study involving ambulance visits with the leading documented diagnoses of migraine made between 1 July and 31 December 2014 by the Tallinn Emergency Service and the Tartu Ambulance Foundation.

Results. Among the patients, 44% treated by the Tartu Ambulance Foundation and 14% treated by the Tallinn Emergency Service had not taken any medications to treat their symptoms prior to calling an ambulance (p < 0.001). Only 9% had taken triptanes. The most significant difference between two ambulance providers occurred in the mode of administrating drugs. The medics of the Tartu Ambulance Foundation administered 80% (n = 94) of the drugs intramuscularly and 22% intravenously (n = 26). The respective indicators for the Tallinn Emergency Service were 20% (n = 28) and 86% (n = 118) (p < 0.001). Opioids, more precisely tramadol, was administered in 50 cases altogether, which accounts for 19.6%.

Conclusion. The theoretical knowledge of the diagnostic criteria and evidence-based treatment of migraine needs to be improved and adjusted among ambulance workers in order to provide better pre-hospital care.