To examine the characteristics and emergency department (ED) management of headache in reproductive age women.

Headache is a frequently encountered problem in the ED. Migraine, the most common primary headache for which individuals seek help, is greatly underdiagnosed. As the ED frequently serves as primary care provider, particularly among women of color, understanding the patterns of diagnosis and management of headache in the ED is vital. This study aims to better understand these patterns in reproductive age women presenting for headache.

Using Clinical Looking Glass, a clinical analytics program with data compiled from the Montefiore Health System (MHS) electronic medical record, all first time ED visits for the primary complaint of headache throughout the MHS from January 2017 to December 2019 were reviewed. Analyses were limited to women aged 18 to 42 with data reporting last menstrual period (LMP).

4,996 women (age 29.4 +/- 7.1) with LMP data presented to a Montefiore ED for the primary complaint of headache. 53.1% self-identified as Hispanic and 33.9% as Black. 17.7% of women had a prior migraine diagnosis and 3.1% had previous triptan use. The highest volume of visits (7%) occurred on the first day of menses. 11% had repeat ED presentation for non-headache concerns within 30 days of their initial presentation. 0.2% received a first-time diagnosis of migraine. Antiemetics were received by 50.8%, NSAIDs by 34.5%, diphenhydramine by 29.2%, and opioids by 4.0%. 7.3% had a migraine diagnosis made after ED visit.

Most reproductive age women seeking care for headache in the ED appear to have undiagnosed primary headache, likely migraine, evidenced by the high number of women presenting during menses, a known migraine trigger, and the high proportion receiving antiemetics. This highlights the significant underdiagnoses of migraine in our population of primarily Hispanic and Black reproductive age women, warranting further exploration.