The Headache in Emergency Departments study: Opioid prescribing in patients presenting with headache. A multicenter, cross‐sectional, observational study
Adult
Male
primary headache disorder
Asia
Headache Disorders
610
Clinical sciences
overuse
Drug Prescriptions
Hospital
03 medical and health sciences
0302 clinical medicine
emergency medicine
80 and over
Humans
Aged
Aged, 80 and over
Analgesics
Emergency Service
Australia
analgesia
Middle Aged
3. Good health
Analgesics, Opioid
Europe
Cross-Sectional Studies
Health Care Surveys
Acute Disease
Practice Guidelines as Topic
opioid
Emergency medicine
Female
Emergency Service, Hospital
New Zealand
DOI:
10.1111/head.14217
Publication Date:
2021-10-11T05:24:50Z
AUTHORS (16)
ABSTRACT
AbstractObjectiveTo describe the patterns of opioid use in patients presenting to the emergency department (ED) with nontraumatic headache by severity and geography.BackgroundInternational guidelines recognize opioids are ineffective in treating primary headache disorders. Globally, many countries are experiencing an opioid crisis. The ED can be a point of initial exposure leading to tolerance for patients. More geographically diverse data are required to inform practice.MethodsThis was a planned, multicenter, cross‐sectional, observational substudy of the international Headache in Emergency Departments (HEAD) study. Participants were prospectively identified throughout March 2019 from 67 hospitals in Europe, Asia, Australia, and New Zealand. Adult patients with nontraumatic headache were included as identified by the local site investigator.ResultsOverall, 4536 patients were enrolled in the HEAD study. Opioids were administered in 1072/4536 (23.6%) patients in the ED, and 386/3792 (10.2%) of discharged patients. High opioid use occurred prehospital in Australia (190/1777, 10.7%) and New Zealand (55/593, 9.3%). Opioid use in the ED was highest in these countries (Australia: 586/1777, 33.0%; New Zealand: 221/593, 37.3%). Opioid prescription on discharge was highest in Singapore (125/442, 28.3%) and Hong Kong (12/49, 24.5%). Independent predictors of ED opioid administration included the following: severe headache (OR 4.2, 95% CI 3.1–5.5), pre‐ED opioid use (OR 1.42, 95% CI 1.11–1.82), and long‐term opioid use (OR 1.80, 95% CI 1.26–2.58). ED opioid administration independently predicted opioid prescription at discharge (OR 8.4, 95% CI 6.3–11.0).ConclusionOpioid prescription for nontraumatic headache in the ED and on discharge varies internationally. Severe headache, prehospital opioid use, and long‐term opioid use predicted ED opioid administration. ED opioid administration was a strong predictor of opioid prescription at discharge. These findings support education around policy and guidelines to ensure adherence to evidence‐based interventions for headache.
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