{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T15:02:14Z","timestamp":1785942134642,"version":"3.56.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate differences in emergency department (ED) utilization and quality of care for migraine in patients with rural and nonrural residences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Migraine is a significant problem in the United States with direct health\u2010care utilization cost amounting to US $4.2 billion annually. A considerable portion of this cost is attributed to more than 4 million annual ED visits for migraine and headache. Previous research has documented health disparities among rural populations in other disease states, which can be influenced by factors such as socioeconomic status and health\u2010care access. Given these associations, it was hypothesized that patients with rural residence in a national sample would have increased ED utilization for migraine compared to patients with nonrural residence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross\u2010sectional epidemiologic study to evaluate rural disparities in ED utilization and quality of care for migraine in the United States in 2019. ED encounter data were collected from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) and Kentucky State Emergency Department Database (KY\u2010SEDD). The primary outcome was crude and age\u2010adjusted rates of ED encounters for migraine per 10,000 population. ED encounters were included if they had a primary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code of G43.xx. ED encounters lacking sufficient data to classify into a geographic group were excluded. Secondary outcomes examined differences in quality of care, including mean ED charges and the proportion of encounters with medication administration, imaging, and nerve block service codes between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred eighty\u2010three thousand two hundred eleven national ED discharges were classified as rural patient encounters and 627,176 were classified as nonrural. The rural group had significantly higher crude and age\u2010adjusted rates of ED utilization for migraine (crude: rural 39.8, 95% confidence interval [CI] 36.9\u201342.7; nonrural 22.2, 95% CI 21\u201323.5 and age\u2010adjusted: rural 41.8, 95% CI 38.8\u201344.8; nonrural 23.4, 95% CI 22.1\u201324.7). Opioid utilization was higher in rural encounters (rural\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926,764, 14.6%; nonrural\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950,367, 8%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). A Kentucky sub\u2010analysis found 5210 ED discharges were classified as Appalachian and 12,551 as non\u2010Appalachian. The Appalachian group had significantly higher ED utilization rates for migraine compared to the non\u2010Appalachian and national rural groups (crude: Appalachian 44.9, 95% CI 43.7\u201346.2; age\u2010adjusted: Appalachian 47.4, 95% CI 46.1\u201348.8). The Kentucky Appalachian group also demonstrated significantly higher opioid analgesia use compared to the national rural group (Appalachian\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091031, 19.8%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests rural populations, particularly in Appalachia, may experience significantly higher ED utilization for migraine compared to nonrural patients. Moreover, rural populations were more likely to receive suboptimal migraine management with opioid analgesia. Multimodal health\u2010care interventions should be developed to improve access to outpatient migraine care and further investigate potential risk factors in the rural population. With high ED utilization, the Appalachian population may benefit most from such an intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14659","type":"journal-article","created":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T02:45:26Z","timestamp":1702435526000},"page":"37-47","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Rural disparities in emergency department utilization for migraine care"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6176-945X","authenticated-orcid":false,"given":"Christian","family":"Rhudy","sequence":"first","affiliation":[{"name":"Specialty Pharmacy and Infusion Services University of Kentucky Healthcare  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aric","family":"Schadler","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Kentucky Children's Hospital University of Kentucky HealthCare  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Huffmyer","sequence":"additional","affiliation":[{"name":"Specialty Pharmacy and Infusion Services University of Kentucky Healthcare  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Porter","sequence":"additional","affiliation":[{"name":"Specialty Pharmacy and Infusion Services University of Kentucky Healthcare  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14024"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30322-3"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102411425960"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12399"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414539055"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102420946710"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14071"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2007.00846.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13797"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14153"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13089"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-1053-3"},{"key":"e_1_2_10_14_1","unstructured":"CMS.Rural\u2010Urban Disparities in Health Care in Medicare. CMS Office of Minority Health;2020."},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.1919"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-013-9847-2"},{"key":"e_1_2_10_17_1","article-title":"Appalachia: where place matters in health","volume":"3","author":"Behringer B","year":"2006","journal-title":"Prev Chronic Dis"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/2150131916632554"},{"key":"e_1_2_10_19_1","unstructured":"Bureau USC.New Census Data Show Differences Between Urban and Rural Populations. US Census Bureau Public Information Office;2016."},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011276"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.33994"},{"key":"e_1_2_10_22_1","volume-title":"HCUP Databases","author":"Healthcare Cost and Utilization Project (HCUP)","year":"2022"},{"key":"e_1_2_10_23_1","volume-title":"HCUP Quality Control Procedures","author":"Healthcare Cost and Utilization Project (HCUP)","year":"2022"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14247"},{"key":"e_1_2_10_25_1","unstructured":"National Center for Health Statistics.NCHS Urban\u2010Rural Classification Scheme for Counties. National Center for Health Statistics Office of Analysis and Epidemiology;2017."},{"key":"e_1_2_10_26_1","unstructured":"Appalachian Regional Commission.Subregions in Appalachia. Appalachian Regional Commission;2021."},{"key":"e_1_2_10_27_1","volume-title":"HCUP CCS\u2010Services and Procedures","author":"Healthcare Cost and Utilization Project","year":"2021"},{"key":"e_1_2_10_28_1","unstructured":"U.S. Census Bureau.Annual County Resident Population Estimates by Age Sex Race and Hispanic Origin: April 1 2010 to July 1 2019 (CC\u2010EST2019\u2010ALLDATA).2020."},{"key":"e_1_2_10_29_1","volume-title":"Older Population in Rural America","author":"Smith AS","year":"2019"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1037\/e583772012-001"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14508"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14456"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a43b32"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181d8fff4"},{"key":"e_1_2_10_35_1","article-title":"Migraine treatment in the emergency department: alternatives to opioids and their effectiveness in relieving migraines and reducing treatment times","volume":"10","author":"Dodson H","year":"2018","journal-title":"Cureus"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2007.07.068"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12491"},{"key":"e_1_2_10_38_1","article-title":"Specialist outreach clinics in primary care and rural hospital settings (Cochrane Review)","volume":"19","author":"Gruen R","year":"2006","journal-title":"Community Eye Health"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.14659","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T10:29:38Z","timestamp":1767608978000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.14659"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,12]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1111\/head.14659"],"URL":"https:\/\/doi.org\/10.1111\/head.14659","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,12]]},"assertion":[{"value":"2023-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}