A Victorian neurologist has made fresh calls for greater hospital and patient engagement in evidence-based headache care after his research showed Australia’s emergency departments are one of the world’s biggest opioid prescribers for primary headache.
Migraine Foundation Chair Professor Tissa Wijeratne co-studied headache-related opioid use in 4,536 patients presenting to 57 hospitals across Australia, New Zealand, Asia and Europe during March 2019.
He found 24% of all patients received opioids while in the ED, and 10% on discharge. Australia was one of the major prescribers, with 11% of patients getting opioids pre-hospital and a third in ED.
Only New Zealand eclipsed Australia’s in-ED prescriptions, with 37% of patients receiving opioids, while Singapore and Hong Kong prescribed the most opioids on discharge (25–28%).
Patients were most likely to receive opioids in ED if they had a severe headache and pre-ED or long-term opioid use, Professor Wijeratne and his team wrote in Headache. They’d also likely go home with opioids if they received them in ED.
This prescribing pattern goes against national and international guidelines which can differ on the best practice for primary headache disorders but agree opioid-use is not the answer.
“Opioid prescribing in primary headache disorders is not evidence-based and increases the risk of medication-overuse headaches,” the authors wrote.
“In migraine, it has been recognised as ineffective, potentially habit forming, and inferior to non-opioid options,” they added.
Non-steroidal anti-inflammatory drugs and triptans may be more appropriate treatments for acute attacks, Professor Wijeratne told the limbic.
Yet, lack of interest, guideline-use and training might prevent their administration.
“[Headaches and migraines are] the most neglected, worst managed, least respected medical disorders worldwide,” Professor Wijeratne said.
“When a disease is not recognised as a sexy, important disease, doctors tend not to read those journals and books [or access educational modules] any more often than usual.”
Instead, clinicians tend to treat symptoms, in this case, headache, and leave underlying disease understanding and management to neurologists, Professor Wijeratne said.
The trouble is, neurological disorders are so common that neurologists can’t manage them all and need extra support, he said.
“We need to establish strong synergy between neurology, emergency departments, general practice and the community [in order to reduce the burden on specialists and improve care]”, he explained.
He hoped that the “large battalion of ED physicians among [the study’s] authorship would generate more interest among ED communities and change the dynamics for better in the future” and that further research would identify effective engagement strategies to reduce the evidence-practice gap in neurology and multidisciplinary circles.