{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:44:10Z","timestamp":1792097050150,"version":"4.4.0"},"reference-count":80,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>We examined trends in management of headache disorders in United States (US) emergency department (ED) visits. We conducted a cross-sectional study using 2007\u20132018 National Hospital Ambulatory Medical Care Survey data. We included adult patient visits (\u226518 years) with a primary ED discharge diagnosis of headache. We classified headache medications by pharmacological group: opioids, butalbital, ergot alkaloids\/triptans, acetaminophen\/nonsteroidal anti-inflammatory drugs (NSAIDs), antiemetics, diphenhydramine, corticosteroids, and intravenous fluids. To obtain reliable estimates, we aggregated data into three time periods: 2007\u20132010, 2011\u20132014, and 2015\u20132018. Using multivariable logistic regression, we examined medication, neuroimaging, and outpatient referral trends, separately. Among headache-related ED visits, opioid use decreased from 54.1% in 2007\u20132010 to 28.3% in 2015\u20132018 (Ptrend &lt; 0.001). There were statistically significant increasing trends in acetaminophen\/NSAIDs, diphenhydramine, and corticosteroids use (all Ptrend &lt; 0.001). Changes in butalbital (6.4%), ergot alkaloid\/triptan (4.7%), antiemetic (59.2% in 2015\u20132018), and neuroimaging (37.3%) use over time were insignificant. Headache-related ED visits with outpatient referral for follow-up increased slightly from 73.3% in 2007\u20132010 to 79.7% in 2015\u20132018 (Ptrend = 0.02). Reflecting evidence-based guideline recommendations for headache management, opioid use substantially decreased from 2007 to 2018 among US headache-related ED visits. Future studies are warranted to identify strategies to promote evidence-based treatment for headaches (e.g., sumatriptan, dexamethasone) and appropriate outpatient referral and reduce unnecessary neuroimaging orders in EDs.<\/jats:p>","DOI":"10.3390\/jcm11051401","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T20:36:30Z","timestamp":1646339790000},"page":"1401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Trends in the Management of Headache Disorders in US Emergency Departments: Analysis of 2007\u20132018 National Hospital Ambulatory Medical Care Survey Data"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5198-8544","authenticated-orcid":false,"given":"Seonkyeong","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulia","family":"Orlova","sequence":"additional","affiliation":[{"name":"Neurology Department, College of Medicine, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigale","family":"Lipe","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7565-3642","authenticated-orcid":false,"given":"Macy","family":"Boren","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan M.","family":"Hincapie-Castillo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haesuk","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"},{"name":"Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Yuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1640-5497","authenticated-orcid":false,"given":"Debbie L.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Adkins","sequence":"additional","affiliation":[{"name":"Health Science Center Libraries, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6590-4770","authenticated-orcid":false,"given":"Wei-Hsuan","family":"Lo-Ciganic","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"},{"name":"Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1468-2982.2007.01288.x","article-title":"The global burden of headache: A documentation of headache prevalence and disability worldwide","volume":"27","author":"Stovner","year":"2007","journal-title":"Cephalalgia"},{"key":"ref_2","unstructured":"(2021, November 30). 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