Evaluation of the therapeutic management of patients who visit the emergency department for treatment of acute migraine attack

Evaluation of the therapeutic management of patients who visit the emergency department for treatment of acute migraine attack | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the therapeutic management of patients who visit the emergency department for treatment of acute migraine attack Fortuna MINKA, Oceane MINKA, Xavier EYER, Christophe CHOQUET, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7964381/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: To analyze the therapeutic management of patients consulting in the emergency department to relieve an acute migraine attack to determine whether it complied with the recommendations of the French Headache Society. Methods: We conducted an observational multicenter cohort prospective study. The patients included were adults (age ≥ 18 years) consulting in the emergency department (Lariboisière or Bichat Hospital) for the management of acute migraine attacks of moderate to severe intensity. The data was collected from October 1, 2021, to January 31, 2023. The primary endpoint was the proportion of patients reporting complete pain relief two hours after first-line treatment in the emergency department. Descriptive and stratified analyses of the data collected were performed. A logistic regression model was fitted to assess the association between complete relief and predictor variables. Results: Our sample included 178 patients. The median age was 33 years. Most patients were female (75%). To treat acute migraine attacks, 139 (78%) patients received first-line combination therapy. In most cases, this combination therapy included acetaminophen, metoclopramide, and clorazepate dipotassium. Triptans were administered to two patients. Seventy (45%) patients reported complete pain relief two hours after first-line treatment in the emergency department. Multivariate logistic regression identified age category [34–44] years as significantly associated with a higher probability of complete relief (OR = 10.1, 95% CI = 3.10–39.5, p < 0.001). Conclusions: The French therapeutic recommendations for the relief of acute migraine attacks were not sufficiently applied in two emergency departments. Statistical Epidemiology acute migraine attack emergency department combination therapy pain relief French recommendations Figures Figure 1 Figure 2 Introduction Currently, migraines are the second leading cause of disability worldwide, the leading cause in young adults, with an estimated global prevalence of 15.2%, and the cause of 4.9% of all years lived with disability ( 1 ). Migraines are twice as common in women as in men ( 2 ). Migraines are the most common form of primary headache ( 3 ). The diagnosis of migraine is clinical and does not require additional tests ( 4 ), except to eliminate secondary causes of headaches ( 5 ). Migraines are a common reason for emergency department visits ( 6 ), and the goal of urgent management of acute migraine attacks is headache relief ( 6 ). To this end, non-specific (i.e., aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, metoclopramide) and specific (i.e., triptans) treatments can be used ( 6 , 7 ). The French Headache Society’s 2016 guidelines for the emergency management of headaches recommend adapting treatment based on the medications the patient has already taken ( 8 ). For those who have not taken any treatment, a first-line combination of NSAIDs, metoclopramide, and hydroxyzine is recommended ( 8 ). If the attack persists despite this treatment, the recommendation is to use a triptan drug as a second line of treatment ( 8 ). For those who have already taken NSAIDs, a combination of triptan, metoclopramide, and hydroxyzine is recommended ( 8 ). The recommended treatment for those who have already taken a triptan drug is a combination of NSAIDs, metoclopramide, and hydroxyzine ( 8 ). The intravenous route is to be used when the oral route is not possible ( 8 ). Metoclopramide is to be used for its antinausea and antimigraine effects and hydroxyzine for its anticholinergic effect to limit metoclopramide-induced akathisia ( 8 ). The French Headache Society’s updated 2021 recommendations focus on the therapeutic management of acute migraine according to the intensity of the attack ( 9 ). For mild attacks, NSAIDs are recommended as first line treatment, with the addition of a triptan drug if there is insufficient response after one hour ( 9 ). For moderate or severe attacks, it is recommended to give a triptan drug as the first-line treatment, adding NSAIDs if there is insufficient response after one hour ( 9 ). For migraines with aura, it is recommended to give NSAIDs at the beginning of the aura phase and, if there is insufficient response, a triptan drug in the headache phase ( 10 ). The combination of paracetamol and metoclopramide is recommended in the case of contraindication or intolerance to NSAIDs, aspirin or triptan drugs ( 9 ). The objective of our study was to determine whether the recommendations of the French Headache Society were being applied in our emergency department. Methods Design and setting We conducted an observational, multicenter, prospective, real-life study using the data collected from a standardized case report form (CRF). The study focused on patients consulting in the emergency department for moderate or severe acute migraine attacks from October 1, 2021, to January 31, 2023, at two academic hospitals in the North Paris metropolitan area: Lariboisière Hospital and Bichat Hospital. Selection of participants The inclusion criteria were as follows: adult patients ≥ 18 years old, consultation in the emergency department of Bichat or Lariboisière Hospital for moderate or severe acute migraine attack (numeric rating scale (NRS) ≥ 4), diagnosis of migraine according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) ( 3 ), and first-line treatment with the doctor’s choice of monotherapy or combination therapy (≥ two medications needed) ( 11 ). The exclusion criteria were as follows: pregnant or breastfeeding women, incarcerated persons, other causes of primary or secondary headache, mild acute migraine attack (NRS ≤ 3), context of acute or chronic alcohol intoxication, allergy or contraindication to the use of common analgesics, refusal to participate or already participating in another study, patients who had not received any medication, patients whose pain intensity was not assessed and duplicates or missing data. Outcomes The primary endpoint was the proportion of patients reporting complete pain relief two hours after first-line treatment (monotherapy or combination therapy) in the emergency department. The secondary outcomes were as follows: proportion of additional therapies (drugs used to relieve the acute migraine attack when first-line treatment was not sufficient), type of additional therapies, and proportion of additional examinations performed during emergency department visit (biological assessment and brain imaging). Power analysis The study enrolled 178 patients presenting with acute migraine attacks, of whom 154 had complete data for the primary outcome. In this observational study, the final sample size was determined by consecutive recruitment during the study period and feasibility considerations, rather than a formal a priori calculation. Despite this limitation, the data obtained provide valuable real-world descriptive information that can guide future adequately powered investigations. Data collection and preparation The dataset included demographic and clinical variables such as patient age, sex, migraine intensity, aura presence, previous acute medication at home, and type of first-line drugs used in emergency department to relieve migraine, with a focus on the outcome variable “Pain relief at two hours,” indicating relief status divided into three categories: complete, partial, and no relief. Column types were initially specified as a mix of numeric and text formats to ensure proper import; in cases of import failure, a fallback to default type detection was implemented. Column names were validated to exclude empty or NA values, ensuring data integrity. Missing value analysis was performed on key variables (pain relief at two hours, age, sex, pain intensity, aura presence, preventive treatment, previous acute medication at home, first and second-line drugs in emergency department). “Complete relief” was derived as a binary variable (1 for "complete" relief, 0 otherwise) based on the lowercase transformation of the initial variable “Pain relief at two hours”. Categorical variables were converted to factors using the dplyr (version 1.1.2) and forcats (version 1.0.0) packages, with levels defined as follows: Sex ("Female," "Male"), Pain intensity ("Moderate," "Severe"), Aura ("No," "Yes"), Previous acute medication at home ("No," "Yes"), and Type of drugs used in emergency department (collapsed into "Combined therapy with NSAIDs," "Combined therapy with analgesic, antiemetic, and anxiolytic," "Ketoprofen," "Acetaminophen," and "Triptan"). A continuous numeric variable such as “age” was converted into a categorical variable by dividing it into classes with intervals according to the median and interquartile range. For logistic regression, a subset of complete cases was created by filtering the non-missing values on the dependent variable ("Complete relief"), and the unused factor levels for the remaining variables were removed using droplevels. Statistical analysis We performed descriptive and stratified analysis of the sample according to previous acute medication at home. Quantitative variables were presented as medians (interquartile ranges), and qualitative variables were presented as counts (percentages). There was no imputation of missing data in the analysis. The statistical analysis was performed with the gtsummary package from RStudio software (2024.09.1 + 394). We also performed a univariate and then multivariate logistic regression model using the glm function with a binomial family to assess the association between complete cases of the dependent variable “Complete relief” and other independent variables. Variables with p ≤ 0.2 in univariable screening entered a backward stepwise selection to derive the final parsimonious model. A two-sided p < 0.05 was considered significant. Model convergence was verified, and coefficients were exponentiated to obtain odds ratios (ORs) using the gtsummary package (version 1.7.2). Model fit was evaluated using the Akaike Information Criterion (AIC) and the residual deviance. Outliers with residual values ​​greater than 2 standard deviations were removed to improve the accuracy of the final model results. Results were summarized in a table presenting ORs, 95% confidence intervals (CIs), and p-values, styled with kableExtra (version 1.3.4) and saved as an HTML file. Ethical and regulatory aspects The study protocol was registered prospectively at the Saint-Louis Lariboisière and Fernand-Widal Clinical Research Unit. It was approved by the Paris Nord Research Ethics Committee (Institutional Review Board -IRB 00006477- of HUPNVS, Paris 7 University, AP-HP). Patients’ non-opposition was collected before inclusion in the study. Results From October 1, 2021, to January 31, 2023, 1,104 patients with headaches were eligible for this study: 551 (50%) at Bichat Hospital and 553 (50%) at Lariboisière Hospital. A total of 926 (84%) patients with headaches were not included. The reasons for non-inclusion are presented in the flow chart. Finally, 178 (16%) patients with moderate or severe acute migraine attacks were included: 139 (78%) received combination therapy and 39 (22%) monotherapy (Fig. 1 ). The median patient age was 33 years old (interquartile range, 27–44 years). The sex ratio was 3 females for 1 male. The Lariboisière site treated 122 (69%) patients. The intensity of the migraine attack at admission was severe (NRS ≥ 7) in 113 (63%) patients. Migraine aura symptoms were reported in 53 (30%) patients. Migraine was diagnosed for the first time in the emergency department for 24 (14%) patients. Few patients reported taking preventive treatment (n = 21, 13%). Taking acute medication before arriving at the emergency department was found in 105 (81%) patients: 47 (36%) with acetaminophen, 23 (18%) with a triptan drug, 23 (18%) with NSAIDs, and 8 (6.2%) with NSAIDs and a triptan drug. Seventy (45%) patients reported complete pain relief two hours after first-line treatment in the emergency department. Non-serious adverse effects such as drowsiness or digestive symptoms were reported in 8 (4.5%) patients. All patients included had normal complementary examinations (Table 1 ). Table 1 : Descriptive analysis of the full cohort Characteristics N N = 178 n (%) Age, years, median [IQR 1 ] 178 33 [27 – 44] Age, categories, years 178 (18,33] 91 (51%) (33,44] 45 (25%) (44,87] 42 (24%) Female 178 133 (75%) Lariboisière Center 178 122 (69%) Severe pain intensity 178 113 (63%) Aura 176 53 (30%) First migraine diagnosis in ED 2 171 24 (14%) Preventive treatment 166 21 (13%) Type of preventive treatment 166 None 145 (87%) Topiramate 3 (1.8%) Amitriptyline 7 (4.2%) Combinations 5 (3%) Oxetorone fumarate 3 (1.8%) Propranolol 3 (1.8%) Previous acute medication at home 130 105 (81%) Type of drugs taken before admission to ED 2 126 None 25 (20%) NSAIDs 3 23 (18%) NSAIDs 3 -Triptan 8 (6.3%) Triptan 23 (18%) Acetaminophen 47 (37%) NRS 4 at admission, median [IQR 1 ] 109 7 [5 – 8] First-line treatment in ED 2 178 Monotherapy 39 (22%) Polytherapy 139 (78%) Number of first-line drugs in ED 2 178 1 39 (22%) 2 20 (11%) 3 81 (46%) >3 38 (21%) Type of first-line drugs in ED 2 143 Ketoprofen 7 (4.9%) Combined therapy with NSAIDs 3 32 (22%) Combined therapy with analgesic, antiemetic, and anxiolytic 5 89 (62%) Acetaminophen 14 (9.8%) Zolmitriptan 1 (0.7%) Pain relief at two hours 154 Complete relief 70 (45%) No relief 9 (6%) Partial relief 75 (49%) Second-line treatment in ED 2 178 31 (17%) Type of second-line drugs in ED 2 167 None 147 (88%) Ketoprofen 7 (4.2%) Combined therapy with NSAIDs 3 4 (2.4%) Acetaminophen 5 (3%) Combined therapy with analgesic, antiemetic, and anxiolytic 5 3 (1.8%) Sumatriptan 1 (0.6%) Adverse effects 177 8 (4.5%) Blood test 176 57 (32%) Brain CT 6 177 57 (32%) Brain MRI 7 176 12 (6.8%) Abbreviations : 1 Median (Q1 - Q3) 2 Emergency department 3 Non-steroidal anti-inflammatory drugs 4 Numerical rating scale 5 In most cases, combination of acetaminophen, metoclopramide and clorazepate dipotassium 6 Computed tomography 7 Magnetic resonance imaging Table 2 presents the results of the stratified analysis by previous acute medication at home. Whatever the stratification group, the first-line treatment given in the emergency department was a combination therapy with an analgesic, antiemetic, and anxiolytic. In most cases, this combination therapy included acetaminophen, metoclopramide, and clorazepate dipotassium. Combination therapy with NSAIDs was most often used in patients who had not taken any medication prior to the emergency department visit. Triptan drugs were administered to two patients who had previously taken a triptan at home. No patients received combined therapy with NSAIDs/triptans in the emergency department. Administration of a second line of medication was rarely necessary. Most patients who visited the emergency department reported receiving partial or complete relief with the first-line medications administered, whether or not they had previously taken acute medication at home (Table 2 ). Table 2 Stratified analysis by treatment taken before admission to emergency department Characteristics N None N = 25 n (%) NSAIDs 1 N = 23 n (%) NSAIDs 1 and Triptans N = 8 n (%) Triptans N = 23 n (%) Acetaminophen N = 47 n (%) Age, years, median [IQR 2 ] 126 33 [26–42] 33 [30–37] 36 [22–48] 40 [29–48] 32 [26–37] Age, categories, years 126 - (18,33] 13 (52%) 14 (61%) 4 (50%) 10 (43%) 28 (60%) - (33,44] 7 (28%) 4 (17%) 2 (25%) 4 (17%) 12 (26%) - (44,87] 5 (20%) 5 (22%) 2 (25%) 9 (39%) 7 (15%) Female 126 16 (64%) 17 (74%) 8 (100%) 18 (78%) 36 (77%) Center 126 - Bichat 9 (36%) 3 (13%) 2 (25%) 3 (13%) 19 (40%) - Lariboisière 16 (64%) 20 (87%) 6 (75%) 20 (87%) 28 (60%) Pain intensity 126 - Moderate 8 (32%) 6 (26%) 2 (25%) 5 (22%) 20 (43%) - Severe 17 (68%) 17 (74%) 6 (75%) 18 (78%) 27 (57%) Aura 124 10 (40%) 8 (36%) 0 (0%) 7 (30%) 13 (28%) First migraine diagnosis in ED 3 122 6 (25%) 2 (8.7%) 1 (13%) 0 (0%) 4 (9.1%) Preventive treatment 118 4 (17%) 2 (9.5%) 2 (25%) 5 (25%) 5 (11%) Type of preventive treatment 118 - None 20 (83%) 19 (90%) 6 (75%) 15 (75%) 40 (89%) - Topiramate 1 (4.2%) 1 (4.8%) 0 (0%) 1 (5.0%) 0 (0%) - Amitriptyline 1 (4.2%) 0 (0%) 0 (0%) 2 (10%) 3 (6.7%) - Combinations 1 (4.2%) 1 (4.8%) 2 (25%) 0 (0%) 0 (0%) - Oxetorone fumarate 1 (4.2%) 0 (0%) 0 (0%) 1 (5.0%) 1 (2.2%) - Propranolol 0 (0%) 0 (0%) 0 (0%) 1 (5.0%) 1 (2.2%) NRS 4 at admission, median [IQR 2 ] 73 7 [4–8] 6 [5–8] 8 [7–8] 8 [7–9] 6 [5–8] First-line treatment in ED 3 126 - Monotherapy 5 (20%) 3 (13%) 1 (13%) 1 (4.3%) 13 (28%) - Polytherapy 20 (80%) 20 (87%) 7 (88%) 22 (96%) 34 (72%) Number of first-line drugs in ED 3 , median [IQR 2 ] 126 3 [2–3] 3 [3–3] 3 [3–3] 3 [3–4] 3 [1–3] Type of first-line drugs in ED 3 105 - Ketoprofen 0 (0%) 0 (0%) 0 (0%) 0 (0%) 5 (14%) - Combined therapy with NSAIDs 1 9 (43%) 4 (18%) 0 (0%) 3 (14%) 7 (20%) - Combined therapy with analgesic, antiemetic, and anxiolytic 5 10 (48%) 15 (68%) 6 (100%) 17 (81%) 20 (57%) - Acetaminophen 2 (9.5%) 3 (14%) 0 (0%) 0 (0%) 3 (8.6%) - Zolmitriptan 0 (0%) 0 (0%) 0 (0%) 1 (4.8%) 0 (0%) Pain relief at two hours 115 - Complete relief 13 (59%) 7 (32%) 2 (33%) 10 (43%) 20 (48%) - No relief 0 (0%) 3 (14%) 0 (0%) 0 (0%) 4 (9.5%) - Partial relief 9 (41%) 12 (55%) 4 (67%) 13 (57%) 18 (43%) Type of second-line drugs in ED 3 117 - None 23 (92%) 15 (75%) 7 (88%) 19 (90%) 36 (84%) - Ketoprofen 0 (0%) 3 (15%) 0 (0%) 0 (0%) 2 (4.7%) - Combined therapy with NSAIDs 1 0 (0%) 1 (5.0%) 1 (13%) 0 (0%) 2 (4.7%) - Acetaminophen 1 (4.0%) 0 (0%) 0 (0%) 1 (4.8%) 2 (4.7%) - Combined therapy with analgesic, antiemetic, and anxiolytic 5 1 (4.0%) 1 (5.0%) 0 (0%) 0 (0%) 1 (2.3%) - Sumatriptan 0 (0%) 0 (0%) 0 (0%) 1 (4.8%) 0 (0%) Abbreviations : 1 Non-steroidal anti-inflammatory drugs 2 Median (Q1 - Q3) 3 Emergency department 4 Numerical rating scale 5 In most cases, combination of acetaminophen, metoclopramide and clorazepate dipotassium A logistic regression model was fitted to assess the association between complete relief (dependent variable) and predictor variables. The initial dataset included 178 patients and 40 variables. After removing cases with missing dependent variables, 154 cases remained. After removing the cases with residuals greater than 2 standard deviations, 146 cases remained in our final model. The model converged successfully, with an Akaike Information Criterion (AIC) of 128 and a residual deviance of 116 on 96 degrees of freedom. In the multivariate analysis, the age category 34–44 years was significantly associated with a higher odds ratio of complete migraine relief compared to the age category 18–33 years (odds ratio [OR] = 10.1, 95% confidence interval [95% CI] = 3.10–39.5, p-value [p] < 0.001). Male showed a non-significant trend toward increased odds ratio of complete migraine relief (OR = 2.20, 95% CI = 0.81–6.16, p = 0.12). Preventive treatment and Previous acute medication at home showed a non-significant trend toward a reduced odds ratio for complete migraine relief (OR = 0.29, 95% CI = 0.06–1.07, p = 0.081 ; OR = 0.38, 95% CI = 0.12–1.15, p = 0.091) (Table 3 ). Table 3 Univariate and multivariate logistic regression of predictors of complete relief Univariate model Multivariate model Characteristics N OR 1 95% CI 1 p-value OR 1 95% CI 1 p-value Age, years 146 1.02 1.0–1.05 0.12 Age, categories, years 146 - (18,33] — — — — - (33,44] 3.58 1.56–8.68 0.003 10.1 3.10–39.5 < 0.001 - (44,87] 1.25 0.56–2.79 0.6 2.01 0.72–5.67 0.2 Male 146 1.60 0.76–3.41 0.2 2.20 0.81–6.16 0.12 Lariboisière center 146 0.77 0.36–1.64 0.5 Severe Pain intensity 146 0.77 0.38–1.56 0.5 Aura 144 1.17 0.58–2.40 0.7 First migraine diagnosis in ED 2 143 1.35 0.51–3.62 0.5 Preventive treatment 137 0.40 0.12–1.15 0.10 0.29 0.06–1.07 0.081 Type of preventive treatment 137 - None — — - Topiramate 0.00 > 0.9 - Amitriptyline 0.26 0.01–1.84 0.2 - Combinations 0.70 0.09–4.38 0.7 - Oxetorone fumarate 0.53 0.02–5.63 0.6 - Propranolol 1.05 0.04–27.0 > 0.9 Previous acute medication at home 109 0.45 0.16–1.17 0.11 0.38 0.12–1.15 0.091 Type of drugs taken before admission to ED 2 107 - None — — - NSAIDs 3 0.31 0.08–1.06 0.068 - NSAIDs 3 -Triptan 0.31 0.04–1.96 0.2 - Triptan 0.46 0.13–1.56 0.2 - Acetaminophen 0.62 0.20–1.80 0.4 NRS 4 at admission 84 0.98 0.77–1.24 0.9 Polytherapy First-line treatment 146 1.79 0.72–4.72 0.2 Number of first-line treatment 146 1.16 0.85–1.59 0.4 Type of first-line treatment in ED 2 122 - Ketoprofen — — - Combined therapy with NSAIDs 3 2.91 0.48–23.7 0.3 - Combined therapy with analgesic, antiemetic, and anxiolytic 5 1.86 0.34–13.9 0.5 - Acetaminophen 1.50 0.16–16.8 0.7 - Zolmitriptan 0.00 > 0.9 Abbreviations : 1 OR = odds ratio, CI = confidence interval 2 Emergency department 3 Non-steroidal anti-inflammatory drugs 4 Numeric rating scale 5 In most cases, combination of acetaminophen, metoclopramide and clorazepate dipotassium A forest plot was generated to visualize the odds ratios and 95% confidence intervals from the multivariate logistic regression (Fig. 2 ). Discussion In our study we observed that 70 (45%) patients reported complete pain relief two hours after first-line treatment in the emergency department. The combination of paracetamol, metoclopramide, and clorazepate dipotassium was the most often prescribed in the emergency department; few patients received first-line monotherapy with triptans, and no patients received combination therapy with NSAIDs/triptans. These observations are in line with previous studies reporting that the therapeutic management of migraine in the emergency department was very heterogeneous, triptans were underused, and international guidelines were not applied ( 12 – 14 ). Both the American Headache Society and the French Headache Society recommend the use of non-specific analgesics as first-line treatment for mild to moderate acute migraine attacks and to reserve specific analgesics for moderate to severe acute migraine attacks, or for mild to moderate acute migraine attacks that do not respond adequately to non-specific analgesics ( 6 , 15 ). In 2019, the European Headache Federation published guidelines for the management of acute migraine attacks in primary care ( 16 ). In our study, two thirds of patients had a severe migraine attack on admission. However, specific analgesics like triptans were only administered to two patients who had already taken triptans at home, which highlights a lack of compliance with French and American recommendations in our emergency department ( 8 , 9 , 15 ). Also, paracetamol was sometimes used as the only first-line treatment in the emergency department; this represents suboptimal management, which could lead to fears of recurrence of headaches when leaving the emergency department. Metoclopramide is recommended in acute migraine attacks for its anti-dopaminergic effect; and to limit metoclopramide-induced akathisia, it is recommended to combine it with an anticholinergic drug such as hydroxyzine ( 6 , 8 ). However, in our study, we found that instead of hydroxyzine, benzodiazepines like clorazepate dipotassium or diazepam were used. These medications have never been recommended for the treatment of acute migraine attack in France or the United States ( 8 , 9 , 15 ). In case of insufficient response to NSAIDs and triptans, the French Headache Society recommends consulting a specialist regarding the use of medications such as amitriptyline, dexamethasone, or chlorpromazine ( 8 ). None of these drugs were used for this indication in our study. The issue of non-responders to triptans is addressed in the French Headache Society’s updated recommendations from 2024 ( 17 ). A first solution would be to change triptans until the molecule that is effective for the patient is identified ( 18 ). Another solution would be to use the sumatriptan-naproxen sodium combination, which would be the most effective for migraine attacks ( 19 ); however, this association is still not marketed in France ( 17 ). And finally, if there is no response to the triptan, it is possible to change therapeutic class and use gepants; these have just obtained marketing authorization in France ( 17 ). Unfortunately, these recommendations are specifically formulated for the management of migraine attacks in the outpatient setting. We hope that future recommendations will facilitate the use of specific analgesics for the treatment of migraine attacks in the emergency department setting. Combination therapy was the most often prescribed. One explanation is the fact that combination therapy simultaneously modulates several pathophysiological mechanisms at the origin of migraine attacks, including inflammation, hypersensitivity to dopamine, and relatively low serotonin levels, as well as treating anxiety induced by the attacks ( 20 ). Conversely, monotherapy focusing on a single biological system will not result in rapid, consistent, and complete migraine relief ( 20 ). We found that the type of first-line treatment used in the emergency department showed the greatest heterogeneity but was associated with higher odds of complete relief in univariate analysis. This variable was not included in the multivariate model because it did not improve the accuracy of the final model; thus, these results require cautious interpretation due to limited sample size and power. The sociodemographic characteristics found in our study were comparable to those reported in the literature: migraines affect women more frequently in the third decade of their life ( 2 , 13 , 14 , 21 , 22 ). Multivariate analysis revealed that age category 34–44 years was significantly associated with a higher probability of complete pain relief (OR = 10.1), and male gender tended toward a greater probability of relief (OR = 2.20) but did not reach significance. The reasons for gender disparity in migraines remain obscure ( 23 ). However, These results are consistent with the literature since a previous study reported that age was often significantly associated with short-term migraine relief in the emergency department ( 24 ). This finding warrants further investigation of age-related migraine characteristics or differences in care. Although the diagnosis of migraine was clinical, additional tests were performed in the emergency department for two-thirds of patients. This practice, also observed in other studies, can be explained by practitioners’ fear of neglecting a secondary cause of headaches like stroke, cerebral venous thrombosis, or aneurysm ( 25 – 27 ). Strengths First, this was a multicenter study with prospective data collection. Second, the primary endpoint is relevant and consistent with the guidelines of the French Headache Society. Third, we used a standardized form for data collection. Fourth, all patients included in our study were treated. And finally, we found no other studies that aimed to determine predictors associated with complete migraine relief, only studies examining predictors of emergency departments visits ( 28 , 29 ) or related to the need to use second-line treatment in the emergency department ( 30 ). Limitations First, this observational study did not identify a causal link between the different associations found. Second, we found a strong heterogeneity in the drugs used in this study. Third, our analyses ignored missing data. Fourth, we did not measure the effect of non-drug measures (dark, quiet rest) on migraine relief. Fifth, our study did not quantify the degree of pain relief because we used a subjective rating scale as recommended by the French Headache Society. Sixth, we did not evaluate the relief of associated symptoms, the persistence of pain relief at 24 hours, or the ability to do activities. And finally, we did not estimate a priori the number of subjects needed for this study, so the lack of statistical significance of some of our results can be interpreted as a lack of power. For future research aiming to detect a clinically meaningful improvement of 10% in complete migraine relief (from 45% to 55%) with 80% power and α = 0.05, the required sample size would be approximately 195 participants. Conclusions The French therapeutic recommendations for the relief of acute migraine attacks were not sufficiently applied in two emergency departments. It is essential to provide continuous training for health professionals. References Steiner TJ, Stovner LJ. Global epidemiology of migraine and its implications for public health and health policy. Nat Rev Neurol. 2023 Feb 1;19(2):109–17. Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017 Jan 1;16(1):76–87. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan 1;38(1):1–211. G. Demarquay, X. Moisset, M. Lantéri-Minet, S. de Gaalon, A. Donnet, P. Giraud, et al. Revised guidelines of the French Headache Society for the diagnosis and management of migraine in adults. Part 1: Diagnosis and assessment. Rev Neurol (Paris). 2021 Sep;7199(7):723. Wolf SJ, Byyny R, Carpenter CR, Diercks DB, Gemme SR, Gerardo CJ, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Ann Emerg Med. 2019 Oct 1;74(4):e41–74. Cortel-LeBlanc MA, Orr SL, Dunn M, James D, Cortel-LeBlanc A. Managing and Preventing Migraine in the Emergency Department: A Review. Ann Emerg Med. 2023 Dec 1;82(6):732–51. VanderPluym JH, Halker Singh RB, Urtecho M, Morrow AS, Nayfeh T, Torres Roldan VD, et al. Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis. JAMA. 2021 Jun 15;325(23):2357–69. Moisset X, Mawet J, Guegan-Massardier E, Bozzolo E, Gilard V, Tollard E, et al. French Guidelines For the Emergency Management of Headaches. Rev Neurol (Paris). 2016 Jun 1;172(6):350–60. Ducros A, de Gaalon S, Roos C, Donnet A, Giraud P, Guégan-Massardier E, et al. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment. Journ Int SFN 2021. 2021 Sep 1;177(7):734–52. Lucas C. Migraine with aura. Journ Int SFN 2021. 2021 Sep 1;177(7):779–84. Lipton RB, Ailani J, Blumenfeld AM. What Is Combination Treatment in Migraine? Moving Toward a Uniform Definition of a Familiar Principle. Neurol Ther. 2024 Dec 1;13(6):1535–40. Lim JH, Karimi L, Wijeratne T. An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review. J Clin Med. 2021;10(6). Navarro-Pérez MP, Ballesta-Martínez S, Rodríguez-Montolio J, Bellosta-Diago E, García-Noaín JA, Santos-Lasaosa S. Acute migraine management in the emergency department: experience from a large Spanish tertiary hospital. Intern Emerg Med. 2021 Nov 1;16(8):2243–9. Wijeratne T, Kuan WS, Kelly AM, Chu KH, Kinnear FB, Keijzers G, et al. Migraine in the Emergency Department: A Prospective Multinational Study of Patient Characteristics, Management, and Outcomes. Neuroepidemiology. 2022 Feb 8;56(1):32–40. Ailani J, Burch RC, Robbins MS, the Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache J Head Face Pain. 2021 Jul 1;61(7):1021–39. Steiner TJ, Jensen R, Katsarava Z, Linde M, MacGregor EA, Osipova V, et al. Aids to management of headache disorders in primary care (2nd edition). J Headache Pain. 2019 May 21;20(1):57. Moisset X, Demarquay G, de Gaalon S, Roos C, Donnet A, Giraud P, et al. Migraine treatment: Position paper of the French Headache Society. Rev Neurol (Paris). 2024 Dec 1;180(10):1087–99. Ruscheweyh R, Gossrau G, Dresler T, Freilinger T, Förderreuther S, Gaul C, et al. Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023 Oct 10;24(1):135. Wilcha RJ, Afridi SK, Barbanti P, Diener HC, Jürgens TP, Lanteri-Minet M, et al. Sumatriptan-naproxen sodium in migraine: A review. Eur J Neurol. 2024 Sep 1;31(S2):e16434. Krymchantowski AV, Bigal ME. Polytherapy in the preventive and acute treatment of migraine: fundamentals for changing the approach. Expert Rev Neurother. 2006 Mar 1;6(3):283–9. Sanchez Trujillo LA, Pastrana ME, Galnares Olalde JA, Marfil A, Partida Medina LR, Gudiño Castelazo M, et al. The burden of migraine in Mexico: a database analysis of migraine-related visits to emergency departments in Mexico’s Ministry of Health (MMoH) hospitals. Expert Rev Neurother. 2025 Apr 3;25(4):491–500. Caponnetto V, Deodato M, Robotti M, Koutsokera M, Pozzilli V, Galati C, et al. Comorbidities of primary headache disorders: a literature review with meta-analysis. J Headache Pain. 2021 Jul 14;22(1):71. Rossi MF, Tumminello A, Marconi M, Gualano MR, Santoro PE, Malorni W, et al. Sex and gender differences in migraines: a narrative review. Neurol Sci. 2022 Sep 1;43(9):5729–34. Friedman BW, Cisewski DH, Holden L, Bijur PE, Gallagher EJ. Age But Not Sex Is Associated With Efficacy and Adverse Events Following Administration of Intravenous Migraine Medication: An Analysis of a Clinical Trial Database. Headache J Head Face Pain. 2015 Nov 1;55(10):1342–55. Ridolfi M, Granato A, Polverino P, Furlanis G, Ukmar M, Zorzenon I, et al. Migrainous aura as stroke-mimic: The role of perfusion-computed tomography. Clin Neurol Neurosurg. 2018 Mar 1;166:131–5. Kelly AM, Kuan WS, Chu KH, Kinnear FB, Keijzers G, Karamercan MA, et al. Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)—A multinational observational study. Headache J Head Face Pain. 2021 Nov 1;61(10):1539–52. Vo P, Gao W, Zichlin ML, Fuqua E, Fadli E, Aguirre Vazquez M, et al. Migraine-related healthcare resource use in the emergency department setting: a panel-based chart review in France, Germany, Italy, and Spain. J Med Econ. 2019 Sep 2;22(9):960–6. Drangova H, Kofmel N, Branca M, Gloor D, Lehmann B, Exadaktylos A, et al. The potential to prevent unnecessary emergency department visits by timely diagnosis of migraine–A prospective observational study. PLOS ONE. 2024 Oct 18;19(10):e0312106. Minen MT, Loder E, Friedman B. Factors Associated With Emergency Department Visits for Migraine: An Observational Study. Headache J Head Face Pain. 2014 Nov 1;54(10):1611–8. Wells S, Stiell IG, Vishnyakova E, Lun R, Nemnom MJ, Perry JJ. Optimal management strategies for primary headache in the emergency department. Can J Emerg Med. 2021 Nov 1;23(6):802–11. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7964381","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":535967623,"identity":"18f61a37-8ff5-453f-a90c-0bf3b6b07fc8","order_by":0,"name":"Fortuna MINKA","email":"","orcid":"","institution":"Pharmacy Department, UFR Santé, University of Franche-Comté, 19 rue Ambroise Pare, 25 000, Besançon, France","correspondingAuthor":false,"prefix":"","firstName":"Fortuna","middleName":"","lastName":"MINKA","suffix":""},{"id":535968005,"identity":"84d1ff2c-27d6-4a40-b9b9-d7c5eb989467","order_by":1,"name":"Oceane MINKA","email":"","orcid":"","institution":"Emergency Department, Bichat Hospital, Assistance publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France","correspondingAuthor":false,"prefix":"","firstName":"Oceane","middleName":"","lastName":"MINKA","suffix":""},{"id":535968006,"identity":"a1dbdb90-96bd-4add-a97d-893382a6aa14","order_by":2,"name":"Xavier EYER","email":"","orcid":"","institution":"Emergency Department, Lariboisière Hospital, Assistance publique—Hôpitaux de Paris, 2 rue Ambroise Pare, 75010, Paris, France","correspondingAuthor":false,"prefix":"","firstName":"Xavier","middleName":"","lastName":"EYER","suffix":""},{"id":535968007,"identity":"8c2fc202-2e08-458f-9e40-3cbb323027a7","order_by":3,"name":"Christophe CHOQUET","email":"","orcid":"","institution":"Emergency Department, Bichat Hospital, Assistance publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France","correspondingAuthor":false,"prefix":"","firstName":"Christophe","middleName":"","lastName":"CHOQUET","suffix":""},{"id":535968008,"identity":"0571c074-0560-4e77-b02e-3ae05042bf73","order_by":4,"name":"Caroline MINKA","email":"","orcid":"","institution":"Emergency Department, Argenteuil Hospital, 69 rue du Lieutenant Colonel Prudhon, 95107, Argenteuil, France","correspondingAuthor":false,"prefix":"","firstName":"Caroline","middleName":"","lastName":"MINKA","suffix":""},{"id":535968009,"identity":"1be224f2-44e2-47c2-92a9-5b762afe8ec1","order_by":5,"name":"Anthony CHAUVIN","email":"","orcid":"","institution":"Emergency Department, Lariboisière Hospital, Assistance publique—Hôpitaux de Paris, 2 rue Ambroise Pare, 75010, Paris, France","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"CHAUVIN","suffix":""},{"id":535968010,"identity":"daf31303-6876-45a3-a62c-8736f95d683c","order_by":6,"name":"Hillary MINKA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBAC9gYGgwMMDBJAyHyAgbEBLIIf8ByAa2FLAGsBihDWAmZIMPAYEKmF/fDGA4w5FnmS7Wc+fi7ccYeBR5qAHh6etIIDjNskiqV5cjdLzzzzjIGHLwG/FnuGHAOQlsR5DLkbpHnbDjPY8xByGP8bqBb+N49/g7TwENQiAbVltkQOmzSRWp4VHEgEapk545mZ9cy2ZzyEtfAnb/7wcVtd4ozzyY9vF7bdkSOoBQwSoDQzA8MBojQgAEgLaTpGwSgYBaNgRAAAMaJCreg6DncAAAAASUVORK5CYII=","orcid":"","institution":"Emergency Department, Lariboisière Hospital, Assistance publique—Hôpitaux de Paris, 2 rue Ambroise Pare, 75010, Paris, France","correspondingAuthor":true,"prefix":"","firstName":"Hillary","middleName":"","lastName":"MINKA","suffix":""}],"badges":[],"createdAt":"2025-10-28 08:32:44","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7964381/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7964381/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94673518,"identity":"3b30882b-ad25-4115-8f8e-edea2d581835","added_by":"auto","created_at":"2025-10-29 13:41:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106402,"visible":true,"origin":"","legend":"","description":"","filename":"Fullmanuscriptpreprint28102025FORMIG.docx","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/98c41f35d011846c0b6549a3.docx"},{"id":94666650,"identity":"f60c0d0a-19e1-4fc2-abd4-d3645345c68b","added_by":"auto","created_at":"2025-10-29 12:35:19","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs7964381.json","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/e5a787578449a64808153c16.json"},{"id":94666660,"identity":"13244335-aca7-4d2d-af62-4145172c5a51","added_by":"auto","created_at":"2025-10-29 12:35:20","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":132101,"visible":true,"origin":"","legend":"","description":"","filename":"rs79643810enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/24ca6e774391b18eab6f4adb.xml"},{"id":94666656,"identity":"d8d02991-28c5-47db-ada7-4ff7b2e07348","added_by":"auto","created_at":"2025-10-29 12:35:19","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115777,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/9d4636bf5e832f08c5232296.jpeg"},{"id":94666652,"identity":"7251aade-b5cc-4732-bbc5-7d30656a0c65","added_by":"auto","created_at":"2025-10-29 12:35:19","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1074,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/156f2cb37db867b936e16c09.jpeg"},{"id":94672874,"identity":"06b15469-9fad-4eea-b162-cff5604fb718","added_by":"auto","created_at":"2025-10-29 13:41:03","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5587,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/0f9f1cd99986d442c860b8f6.png"},{"id":94666658,"identity":"a7acf38e-995e-435e-8068-a84d31fd42e2","added_by":"auto","created_at":"2025-10-29 12:35:20","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":102290,"visible":true,"origin":"","legend":"","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/2090e0e0724df2fcbd70dd27.jpeg"},{"id":94673107,"identity":"a5c6f692-d0dc-491c-9fda-98600b6fcdee","added_by":"auto","created_at":"2025-10-29 13:41:13","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23948,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/c9177cf82da9240d492b936a.png"},{"id":94666653,"identity":"a27750d9-b813-432f-b6b2-6b4131379b88","added_by":"auto","created_at":"2025-10-29 12:35:19","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":935,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/5574bb23aba652d150cf478d.png"},{"id":94673026,"identity":"7c625907-e293-4065-bc59-c63dbac2a981","added_by":"auto","created_at":"2025-10-29 13:41:10","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5544,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/5bd018de7d4eefcb838dd457.png"},{"id":94666657,"identity":"4476cacc-60bf-46c3-9c26-4f1179f56ada","added_by":"auto","created_at":"2025-10-29 12:35:20","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19583,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinegroupimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/ad0d6655d7d6888b89eed9fc.png"},{"id":94672765,"identity":"4598360d-7560-43d9-b11d-3f6c2219aea3","added_by":"auto","created_at":"2025-10-29 13:40:56","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":130220,"visible":true,"origin":"","legend":"","description":"","filename":"rs79643810structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/96b56e2df12465e51b0b5ab2.xml"},{"id":94672890,"identity":"9d4365dd-721a-4b50-9658-a9433158a016","added_by":"auto","created_at":"2025-10-29 13:41:03","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":133845,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/81079dffcc2c6339d3fb60cf.html"},{"id":94666649,"identity":"dee82f64-3de5-4ed4-8af3-4236e8f801e8","added_by":"auto","created_at":"2025-10-29 12:35:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38742,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart showing patient selection\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/ba1e9591770d8ab9205cc7ed.png"},{"id":94666648,"identity":"275bede6-a84d-4072-b250-195080af1c95","added_by":"auto","created_at":"2025-10-29 12:35:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44111,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of multivariate logistic regression with predictors of complete relief\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/u\u003e : OR = odds ratio, p = p-value\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/e870bc75885a38b0f11c78f8.png"},{"id":94728122,"identity":"8dd13a46-4c52-4fbc-9249-4bc7766478e3","added_by":"auto","created_at":"2025-10-30 07:03:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1311557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7964381/v1/85e1ec11-6653-4845-99bf-7c98b9d39c31.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEvaluation of the therapeutic management of patients who visit the emergency department for treatment of acute migraine attack\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCurrently, migraines are the second leading cause of disability worldwide, the leading cause in young adults, with an estimated global prevalence of 15.2%, and the cause of 4.9% of all years lived with disability (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Migraines are twice as common in women as in men (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Migraines are the most common form of primary headache (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The diagnosis of migraine is clinical and does not require additional tests (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), except to eliminate secondary causes of headaches (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Migraines are a common reason for emergency department visits (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), and the goal of urgent management of acute migraine attacks is headache relief (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). To this end, non-specific (i.e., aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, metoclopramide) and specific (i.e., triptans) treatments can be used (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe French Headache Society\u0026rsquo;s 2016 guidelines for the emergency management of headaches recommend adapting treatment based on the medications the patient has already taken (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). For those who have not taken any treatment, a first-line combination of NSAIDs, metoclopramide, and hydroxyzine is recommended (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). If the attack persists despite this treatment, the recommendation is to use a triptan drug as a second line of treatment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). For those who have already taken NSAIDs, a combination of triptan, metoclopramide, and hydroxyzine is recommended (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The recommended treatment for those who have already taken a triptan drug is a combination of NSAIDs, metoclopramide, and hydroxyzine (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The intravenous route is to be used when the oral route is not possible (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Metoclopramide is to be used for its antinausea and antimigraine effects and hydroxyzine for its anticholinergic effect to limit metoclopramide-induced akathisia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe French Headache Society\u0026rsquo;s updated 2021 recommendations focus on the therapeutic management of acute migraine according to the intensity of the attack (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). For mild attacks, NSAIDs are recommended as first line treatment, with the addition of a triptan drug if there is insufficient response after one hour (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). For moderate or severe attacks, it is recommended to give a triptan drug as the first-line treatment, adding NSAIDs if there is insufficient response after one hour (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). For migraines with aura, it is recommended to give NSAIDs at the beginning of the aura phase and, if there is insufficient response, a triptan drug in the headache phase (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The combination of paracetamol and metoclopramide is recommended in the case of contraindication or intolerance to NSAIDs, aspirin or triptan drugs (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The objective of our study was to determine whether the recommendations of the French Headache Society were being applied in our emergency department.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign and setting\u003c/h2\u003e\u003cp\u003eWe conducted an observational, multicenter, prospective, real-life study using the data collected from a standardized case report form (CRF). The study focused on patients consulting in the emergency department for moderate or severe acute migraine attacks from October 1, 2021, to January 31, 2023, at two academic hospitals in the North Paris metropolitan area: Lariboisi\u0026egrave;re Hospital and Bichat Hospital.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSelection of participants\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were as follows: adult patients\u0026thinsp;\u0026ge;\u0026thinsp;18 years old, consultation in the emergency department of Bichat or Lariboisi\u0026egrave;re Hospital for moderate or severe acute migraine attack (numeric rating scale (NRS)\u0026thinsp;\u0026ge;\u0026thinsp;4), diagnosis of migraine according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and first-line treatment with the doctor\u0026rsquo;s choice of monotherapy or combination therapy (\u0026ge;\u0026thinsp;two medications needed) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe exclusion criteria were as follows: pregnant or breastfeeding women, incarcerated persons, other causes of primary or secondary headache, mild acute migraine attack (NRS\u0026thinsp;\u0026le;\u0026thinsp;3), context of acute or chronic alcohol intoxication, allergy or contraindication to the use of common analgesics, refusal to participate or already participating in another study, patients who had not received any medication, patients whose pain intensity was not assessed and duplicates or missing data.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary endpoint was the proportion of patients reporting complete pain relief two hours after first-line treatment (monotherapy or combination therapy) in the emergency department. The secondary outcomes were as follows: proportion of additional therapies (drugs used to relieve the acute migraine attack when first-line treatment was not sufficient), type of additional therapies, and proportion of additional examinations performed during emergency department visit (biological assessment and brain imaging).\u003c/p\u003e\n\u003ch3\u003ePower analysis\u003c/h3\u003e\n\u003cp\u003eThe study enrolled 178 patients presenting with acute migraine attacks, of whom 154 had complete data for the primary outcome. In this observational study, the final sample size was determined by consecutive recruitment during the study period and feasibility considerations, rather than a formal a priori calculation. Despite this limitation, the data obtained provide valuable real-world descriptive information that can guide future adequately powered investigations.\u003c/p\u003e\n\u003ch3\u003eData collection and preparation\u003c/h3\u003e\n\u003cp\u003eThe dataset included demographic and clinical variables such as patient age, sex, migraine intensity, aura presence, previous acute medication at home, and type of first-line drugs used in emergency department to relieve migraine, with a focus on the outcome variable \u0026ldquo;Pain relief at two hours,\u0026rdquo; indicating relief status divided into three categories: complete, partial, and no relief. Column types were initially specified as a mix of numeric and text formats to ensure proper import; in cases of import failure, a fallback to default type detection was implemented. Column names were validated to exclude empty or NA values, ensuring data integrity.\u003c/p\u003e\u003cp\u003eMissing value analysis was performed on key variables (pain relief at two hours, age, sex, pain intensity, aura presence, preventive treatment, previous acute medication at home, first and second-line drugs in emergency department). \u0026ldquo;Complete relief\u0026rdquo; was derived as a binary variable (1 for \"complete\" relief, 0 otherwise) based on the lowercase transformation of the initial variable \u0026ldquo;Pain relief at two hours\u0026rdquo;. Categorical variables were converted to factors using the dplyr (version 1.1.2) and forcats (version 1.0.0) packages, with levels defined as follows: Sex (\"Female,\" \"Male\"), Pain intensity (\"Moderate,\" \"Severe\"), Aura (\"No,\" \"Yes\"), Previous acute medication at home (\"No,\" \"Yes\"), and Type of drugs used in emergency department (collapsed into \"Combined therapy with NSAIDs,\" \"Combined therapy with analgesic, antiemetic, and anxiolytic,\" \"Ketoprofen,\" \"Acetaminophen,\" and \"Triptan\"). A continuous numeric variable such as \u0026ldquo;age\u0026rdquo; was converted into a categorical variable by dividing it into classes with intervals according to the median and interquartile range. For logistic regression, a subset of complete cases was created by filtering the non-missing values on the dependent variable (\"Complete relief\"), and the unused factor levels for the remaining variables were removed using droplevels.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eWe performed descriptive and stratified analysis of the sample according to previous acute medication at home. Quantitative variables were presented as medians (interquartile ranges), and qualitative variables were presented as counts (percentages). There was no imputation of missing data in the analysis. The statistical analysis was performed with the gtsummary package from RStudio software (2024.09.1\u0026thinsp;+\u0026thinsp;394).\u003c/p\u003e\u003cp\u003eWe also performed a univariate and then multivariate logistic regression model using the glm function with a binomial family to assess the association between complete cases of the dependent variable \u0026ldquo;Complete relief\u0026rdquo; and other independent variables. Variables with p\u0026thinsp;\u0026le;\u0026thinsp;0.2 in univariable screening entered a backward stepwise selection to derive the final parsimonious model. A two-sided p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. Model convergence was verified, and coefficients were exponentiated to obtain odds ratios (ORs) using the gtsummary package (version 1.7.2). Model fit was evaluated using the Akaike Information Criterion (AIC) and the residual deviance. Outliers with residual values ​​greater than 2 standard deviations were removed to improve the accuracy of the final model results. Results were summarized in a table presenting ORs, 95% confidence intervals (CIs), and p-values, styled with kableExtra (version 1.3.4) and saved as an HTML file.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical and regulatory aspects\u003c/h3\u003e\n\u003cp\u003eThe study protocol was registered prospectively at the Saint-Louis Lariboisi\u0026egrave;re and Fernand-Widal Clinical Research Unit. It was approved by the Paris Nord Research Ethics Committee (Institutional Review Board -IRB 00006477- of HUPNVS, Paris 7 University, AP-HP). Patients\u0026rsquo; non-opposition was collected before inclusion in the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFrom October 1, 2021, to January 31, 2023, 1,104 patients with headaches were eligible for this study: 551 (50%) at Bichat Hospital and 553 (50%) at Lariboisi\u0026egrave;re Hospital. A total of 926 (84%) patients with headaches were not included. The reasons for non-inclusion are presented in the flow chart. Finally, 178 (16%) patients with moderate or severe acute migraine attacks were included: 139 (78%) received combination therapy and 39 (22%) monotherapy (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe median patient age was 33 years old (interquartile range, 27\u0026ndash;44 years). The sex ratio was 3 females for 1 male. The Lariboisi\u0026egrave;re site treated 122 (69%) patients. The intensity of the migraine attack at admission was severe (NRS\u0026thinsp;\u0026ge;\u0026thinsp;7) in 113 (63%) patients. Migraine aura symptoms were reported in 53 (30%) patients. Migraine was diagnosed for the first time in the emergency department for 24 (14%) patients. Few patients reported taking preventive treatment (n\u0026thinsp;=\u0026thinsp;21, 13%). Taking acute medication before arriving at the emergency department was found in 105 (81%) patients: 47 (36%) with acetaminophen, 23 (18%) with a triptan drug, 23 (18%) with NSAIDs, and 8 (6.2%) with NSAIDs and a triptan drug. Seventy (45%) patients reported complete pain relief two hours after first-line treatment in the emergency department. Non-serious adverse effects such as drowsiness or digestive symptoms were reported in 8 (4.5%) patients. All patients included had normal complementary examinations (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 1\u003c/u\u003e\u003c/strong\u003e : Descriptive analysis of the full cohort\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"639\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 178\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge, years, median [IQR\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33 [27 \u0026ndash; 44]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge, categories, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003e(18,33]\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003e(33,44]\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003e(44,87]\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e133 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLariboisi\u0026egrave;re Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e122 (69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSevere pain intensity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e113 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFirst migraine diagnosis in ED\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreventive treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of preventive treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eNone\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e145 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eTopiramate\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eAmitriptyline\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eCombinations\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxetorone fumarate\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003ePropranolol\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrevious acute medication at home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of drugs taken before admission to ED\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eNone\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eNSAIDs\u003cem\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/em\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eNSAIDs\u003cem\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/em\u003e-Triptan\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eTriptan\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eAcetaminophen\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNRS\u003cem\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/em\u003e at admission, median [IQR\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 [5 \u0026ndash; 8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFirst-line treatment in ED\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eMonotherapy\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003ePolytherapy\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e139 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of first-line drugs in ED\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003e1\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003e2\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003e3\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e81 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026gt;3\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of first-line drugs in ED\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eKetoprofen\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eCombined therapy with NSAIDs\u003cem\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/em\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eCombined therapy with analgesic,\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eantiemetic, and anxiolytic\u003cem\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e89 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eAcetaminophen\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eZolmitriptan\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePain relief at two hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eComplete relief\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo relief\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003ePartial relief\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSecond-line treatment in ED\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of second-line drugs in ED\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eNone\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e147 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eKetoprofen\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eCombined therapy with NSAIDs\u003cem\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/em\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eAcetaminophen\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eCombined therapy with analgesic,\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eantiemetic, and anxiolytic\u003cem\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eSumatriptan\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdverse effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBlood test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBrain CT\u003cem\u003e\u003csup\u003e6\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBrain MRI\u003cem\u003e\u003csup\u003e7\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAbbreviations\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003e\u003c/em\u003eMedian (Q1 - Q3)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e Emergency department\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e3\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eNon-steroidal anti-inflammatory drugs\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/em\u003e Numerical rating scale\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/em\u003e In most cases, combination of acetaminophen, metoclopramide and clorazepate dipotassium\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e6\u0026nbsp;\u003c/sup\u003e\u003c/em\u003eComputed tomography\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e7\u003c/sup\u003e\u003c/em\u003e Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the results of the stratified analysis by previous acute medication at home. Whatever the stratification group, the first-line treatment given in the emergency department was a combination therapy with an analgesic, antiemetic, and anxiolytic. In most cases, this combination therapy included acetaminophen, metoclopramide, and clorazepate dipotassium. Combination therapy with NSAIDs was most often used in patients who had not taken any medication prior to the emergency department visit. Triptan drugs were administered to two patients who had previously taken a triptan at home. No patients received combined therapy with NSAIDs/triptans in the emergency department. Administration of a second line of medication was rarely necessary. Most patients who visited the emergency department reported receiving partial or complete relief with the first-line medications administered, whether or not they had previously taken acute medication at home (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eStratified analysis by treatment taken before admission to emergency department\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;25\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNSAIDs\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;23\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNSAIDs\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e and Triptans\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;8\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTriptans\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;23\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAcetaminophen\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;47\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, years, median [IQR\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 [26\u0026ndash;42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 [30\u0026ndash;37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 [22\u0026ndash;48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 [29\u0026ndash;48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 [26\u0026ndash;37]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, categories, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- (18,33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- (33,44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- (44,87]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCenter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Bichat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Lariboisi\u0026egrave;re\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain intensity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst migraine diagnosis in ED\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreventive treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of preventive treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- None\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Topiramate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Amitriptyline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combinations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Oxetorone fumarate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Propranolol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNRS\u003csup\u003e\u003cem\u003e4\u003c/em\u003e\u003c/sup\u003e at admission, median [IQR\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 [4\u0026ndash;8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 [5\u0026ndash;8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 [7\u0026ndash;8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 [7\u0026ndash;9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 [5\u0026ndash;8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst-line treatment in ED\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Monotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Polytherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of first-line drugs in ED\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e, median [IQR\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 [2\u0026ndash;3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 [3\u0026ndash;3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 [3\u0026ndash;3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 [3\u0026ndash;4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 [1\u0026ndash;3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of first-line drugs in ED\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Ketoprofen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combined therapy with NSAIDs\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combined therapy with analgesic, antiemetic, and anxiolytic\u003csup\u003e\u003cem\u003e5\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Acetaminophen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Zolmitriptan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain relief at two hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Complete relief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- No relief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Partial relief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of second-line drugs in ED\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- None\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Ketoprofen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combined therapy with NSAIDs\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Acetaminophen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combined therapy with analgesic, antiemetic, and anxiolytic\u003csup\u003e\u003cem\u003e5\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Sumatriptan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eAbbreviations\u003c/span\u003e :\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e Non-steroidal anti-inflammatory drugs\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e Median (Q1 - Q3)\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e Emergency department\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cem\u003e4\u003c/em\u003e\u003c/sup\u003e Numerical rating scale\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cem\u003e5\u003c/em\u003e\u003c/sup\u003e In most cases, combination of acetaminophen, metoclopramide and clorazepate dipotassium\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA logistic regression model was fitted to assess the association between complete relief (dependent variable) and predictor variables. The initial dataset included 178 patients and 40 variables. After removing cases with missing dependent variables, 154 cases remained. After removing the cases with residuals greater than 2 standard deviations, 146 cases remained in our final model. The model converged successfully, with an Akaike Information Criterion (AIC) of 128 and a residual deviance of 116 on 96 degrees of freedom. In the multivariate analysis, the age category 34\u0026ndash;44 years was significantly associated with a higher odds ratio of complete migraine relief compared to the age category 18\u0026ndash;33 years (odds ratio [OR]\u0026thinsp;=\u0026thinsp;10.1, 95% confidence interval [95% CI]\u0026thinsp;=\u0026thinsp;3.10\u0026ndash;39.5, p-value [p]\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Male showed a non-significant trend toward increased odds ratio of complete migraine relief (OR\u0026thinsp;=\u0026thinsp;2.20, 95% CI\u0026thinsp;=\u0026thinsp;0.81\u0026ndash;6.16, p\u0026thinsp;=\u0026thinsp;0.12). Preventive treatment and Previous acute medication at home showed a non-significant trend toward a reduced odds ratio for complete migraine relief (OR\u0026thinsp;=\u0026thinsp;0.29, 95% CI\u0026thinsp;=\u0026thinsp;0.06\u0026ndash;1.07, p\u0026thinsp;=\u0026thinsp;0.081 ; OR\u0026thinsp;=\u0026thinsp;0.38, 95% CI\u0026thinsp;=\u0026thinsp;0.12\u0026ndash;1.15, p\u0026thinsp;=\u0026thinsp;0.091) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eUnivariate and multivariate logistic regression of predictors of complete relief\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eUnivariate model\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariate model\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u0026ndash;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, categories, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- (18,33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- (33,44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.56\u0026ndash;8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.10\u0026ndash;39.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- (44,87]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u0026ndash;2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u0026ndash;5.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u0026ndash;3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u0026ndash;6.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLariboisi\u0026egrave;re center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u0026ndash;1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere Pain intensity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u0026ndash;1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58\u0026ndash;2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst migraine diagnosis in ED\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.51\u0026ndash;3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreventive treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u0026ndash;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u0026ndash;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of preventive treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- None\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Topiramate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Amitriptyline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u0026ndash;1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combinations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u0026ndash;4.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Oxetorone fumarate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u0026ndash;5.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Propranolol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u0026ndash;27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevious acute medication at home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u0026ndash;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u0026ndash;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of drugs taken before admission to ED\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- None\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- NSAIDs\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u0026ndash;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- NSAIDs\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e-Triptan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u0026ndash;1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Triptan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u0026ndash;1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Acetaminophen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.20\u0026ndash;1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNRS\u003csup\u003e\u003cem\u003e4\u003c/em\u003e\u003c/sup\u003e at admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77\u0026ndash;1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolytherapy First-line treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u0026ndash;4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of first-line treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u0026ndash;1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of first-line treatment in ED\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Ketoprofen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combined therapy with NSAIDs\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48\u0026ndash;23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Combined therapy with analgesic,\u003c/p\u003e\n \u003cp\u003eantiemetic, and anxiolytic\u003csup\u003e\u003cem\u003e5\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34\u0026ndash;13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Acetaminophen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u0026ndash;16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Zolmitriptan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAbbreviations\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e OR = odds ratio, CI = confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eEmergency department\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/em\u003e Non-steroidal anti-inflammatory drugs\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/em\u003e Numeric rating scale\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/em\u003e In most cases, combination of acetaminophen, metoclopramide and clorazepate dipotassium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA forest plot was generated to visualize the odds ratios and 95% confidence intervals from the multivariate logistic regression (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study we observed that 70 (45%) patients reported complete pain relief two hours after first-line treatment in the emergency department. The combination of paracetamol, metoclopramide, and clorazepate dipotassium was the most often prescribed in the emergency department; few patients received first-line monotherapy with triptans, and no patients received combination therapy with NSAIDs/triptans. These observations are in line with previous studies reporting that the therapeutic management of migraine in the emergency department was very heterogeneous, triptans were underused, and international guidelines were not applied (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBoth the American Headache Society and the French Headache Society recommend the use of non-specific analgesics as first-line treatment for mild to moderate acute migraine attacks and to reserve specific analgesics for moderate to severe acute migraine attacks, or for mild to moderate acute migraine attacks that do not respond adequately to non-specific analgesics (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In 2019, the European Headache Federation published guidelines for the management of acute migraine attacks in primary care (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn our study, two thirds of patients had a severe migraine attack on admission. However, specific analgesics like triptans were only administered to two patients who had already taken triptans at home, which highlights a lack of compliance with French and American recommendations in our emergency department (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Also, paracetamol was sometimes used as the only first-line treatment in the emergency department; this represents suboptimal management, which could lead to fears of recurrence of headaches when leaving the emergency department. Metoclopramide is recommended in acute migraine attacks for its anti-dopaminergic effect; and to limit metoclopramide-induced akathisia, it is recommended to combine it with an anticholinergic drug such as hydroxyzine (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, in our study, we found that instead of hydroxyzine, benzodiazepines like clorazepate dipotassium or diazepam were used. These medications have never been recommended for the treatment of acute migraine attack in France or the United States (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In case of insufficient response to NSAIDs and triptans, the French Headache Society recommends consulting a specialist regarding the use of medications such as amitriptyline, dexamethasone, or chlorpromazine (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). None of these drugs were used for this indication in our study.\u003c/p\u003e\u003cp\u003eThe issue of non-responders to triptans is addressed in the French Headache Society\u0026rsquo;s updated recommendations from 2024 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). A first solution would be to change triptans until the molecule that is effective for the patient is identified (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Another solution would be to use the sumatriptan-naproxen sodium combination, which would be the most effective for migraine attacks (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e); however, this association is still not marketed in France (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). And finally, if there is no response to the triptan, it is possible to change therapeutic class and use gepants; these have just obtained marketing authorization in France (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Unfortunately, these recommendations are specifically formulated for the management of migraine attacks in the outpatient setting. We hope that future recommendations will facilitate the use of specific analgesics for the treatment of migraine attacks in the emergency department setting.\u003c/p\u003e\u003cp\u003eCombination therapy was the most often prescribed. One explanation is the fact that combination therapy simultaneously modulates several pathophysiological mechanisms at the origin of migraine attacks, including inflammation, hypersensitivity to dopamine, and relatively low serotonin levels, as well as treating anxiety induced by the attacks (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Conversely, monotherapy focusing on a single biological system will not result in rapid, consistent, and complete migraine relief (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). We found that the type of first-line treatment used in the emergency department showed the greatest heterogeneity but was associated with higher odds of complete relief in univariate analysis. This variable was not included in the multivariate model because it did not improve the accuracy of the final model; thus, these results require cautious interpretation due to limited sample size and power.\u003c/p\u003e\u003cp\u003eThe sociodemographic characteristics found in our study were comparable to those reported in the literature: migraines affect women more frequently in the third decade of their life (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Multivariate analysis revealed that age category 34\u0026ndash;44 years was significantly associated with a higher probability of complete pain relief (OR\u0026thinsp;=\u0026thinsp;10.1), and male gender tended toward a greater probability of relief (OR\u0026thinsp;=\u0026thinsp;2.20) but did not reach significance. The reasons for gender disparity in migraines remain obscure (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, These results are consistent with the literature since a previous study reported that age was often significantly associated with short-term migraine relief in the emergency department (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This finding warrants further investigation of age-related migraine characteristics or differences in care.\u003c/p\u003e\u003cp\u003eAlthough the diagnosis of migraine was clinical, additional tests were performed in the emergency department for two-thirds of patients. This practice, also observed in other studies, can be explained by practitioners\u0026rsquo; fear of neglecting a secondary cause of headaches like stroke, cerebral venous thrombosis, or aneurysm (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003eFirst, this was a multicenter study with prospective data collection. Second, the primary endpoint is relevant and consistent with the guidelines of the French Headache Society. Third, we used a standardized form for data collection. Fourth, all patients included in our study were treated. And finally, we found no other studies that aimed to determine predictors associated with complete migraine relief, only studies examining predictors of emergency departments visits (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) or related to the need to use second-line treatment in the emergency department (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eFirst, this observational study did not identify a causal link between the different associations found. Second, we found a strong heterogeneity in the drugs used in this study. Third, our analyses ignored missing data. Fourth, we did not measure the effect of non-drug measures (dark, quiet rest) on migraine relief. Fifth, our study did not quantify the degree of pain relief because we used a subjective rating scale as recommended by the French Headache Society. Sixth, we did not evaluate the relief of associated symptoms, the persistence of pain relief at 24 hours, or the ability to do activities. And finally, we did not estimate a priori the number of subjects needed for this study, so the lack of statistical significance of some of our results can be interpreted as a lack of power. For future research aiming to detect a clinically meaningful improvement of 10% in complete migraine relief (from 45% to 55%) with 80% power and α\u0026thinsp;=\u0026thinsp;0.05, the required sample size would be approximately 195 participants.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe French therapeutic recommendations for the relief of acute migraine attacks were not sufficiently applied in two emergency departments. It is essential to provide continuous training for health professionals.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSteiner TJ, Stovner LJ. Global epidemiology of migraine and its implications for public health and health policy. Nat Rev Neurol. 2023 Feb 1;19(2):109\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eVetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017 Jan 1;16(1):76\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eHeadache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan 1;38(1):1\u0026ndash;211. \u003c/li\u003e\n\u003cli\u003eG. Demarquay, X. Moisset, M. Lant\u0026eacute;ri-Minet, S. de Gaalon, A. Donnet, P. Giraud, et al. Revised guidelines of the French Headache Society for the diagnosis and management of migraine in adults. Part 1: Diagnosis and assessment. Rev Neurol (Paris). 2021 Sep;7199(7):723. \u003c/li\u003e\n\u003cli\u003eWolf SJ, Byyny R, Carpenter CR, Diercks DB, Gemme SR, Gerardo CJ, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Ann Emerg Med. 2019 Oct 1;74(4):e41\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eCortel-LeBlanc MA, Orr SL, Dunn M, James D, Cortel-LeBlanc A. Managing and Preventing Migraine in the Emergency Department: A Review. Ann Emerg Med. 2023 Dec 1;82(6):732\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eVanderPluym JH, Halker Singh RB, Urtecho M, Morrow AS, Nayfeh T, Torres Roldan VD, et al. Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis. JAMA. 2021 Jun 15;325(23):2357\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eMoisset X, Mawet J, Guegan-Massardier E, Bozzolo E, Gilard V, Tollard E, et al. French Guidelines For the Emergency Management of Headaches. Rev Neurol (Paris). 2016 Jun 1;172(6):350\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eDucros A, de Gaalon S, Roos C, Donnet A, Giraud P, Gu\u0026eacute;gan-Massardier E, et al. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment. Journ Int SFN 2021. 2021 Sep 1;177(7):734\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eLucas C. Migraine with aura. Journ Int SFN 2021. 2021 Sep 1;177(7):779\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eLipton RB, Ailani J, Blumenfeld AM. What Is Combination Treatment in Migraine? Moving Toward a Uniform Definition of a Familiar Principle. Neurol Ther. 2024 Dec 1;13(6):1535\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eLim JH, Karimi L, Wijeratne T. An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review. J Clin Med. 2021;10(6). \u003c/li\u003e\n\u003cli\u003eNavarro-P\u0026eacute;rez MP, Ballesta-Mart\u0026iacute;nez S, Rodr\u0026iacute;guez-Montolio J, Bellosta-Diago E, Garc\u0026iacute;a-Noa\u0026iacute;n JA, Santos-Lasaosa S. Acute migraine management in the emergency department: experience from a large Spanish tertiary hospital. Intern Emerg Med. 2021 Nov 1;16(8):2243\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eWijeratne T, Kuan WS, Kelly AM, Chu KH, Kinnear FB, Keijzers G, et al. Migraine in the Emergency Department: A Prospective Multinational Study of Patient Characteristics, Management, and Outcomes. Neuroepidemiology. 2022 Feb 8;56(1):32\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eAilani J, Burch RC, Robbins MS, the Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache J Head Face Pain. 2021 Jul 1;61(7):1021\u0026ndash;39. \u003c/li\u003e\n\u003cli\u003eSteiner TJ, Jensen R, Katsarava Z, Linde M, MacGregor EA, Osipova V, et al. Aids to management of headache disorders in primary care (2nd edition). J Headache Pain. 2019 May 21;20(1):57. \u003c/li\u003e\n\u003cli\u003eMoisset X, Demarquay G, de Gaalon S, Roos C, Donnet A, Giraud P, et al. Migraine treatment: Position paper of the French Headache Society. Rev Neurol (Paris). 2024 Dec 1;180(10):1087\u0026ndash;99. \u003c/li\u003e\n\u003cli\u003eRuscheweyh R, Gossrau G, Dresler T, Freilinger T, F\u0026ouml;rderreuther S, Gaul C, et al. Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023 Oct 10;24(1):135. \u003c/li\u003e\n\u003cli\u003eWilcha RJ, Afridi SK, Barbanti P, Diener HC, J\u0026uuml;rgens TP, Lanteri-Minet M, et al. Sumatriptan-naproxen sodium in migraine: A review. Eur J Neurol. 2024 Sep 1;31(S2):e16434. \u003c/li\u003e\n\u003cli\u003eKrymchantowski AV, Bigal ME. Polytherapy in the preventive and acute treatment of migraine: fundamentals for changing the approach. Expert Rev Neurother. 2006 Mar 1;6(3):283\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSanchez Trujillo LA, Pastrana ME, Galnares Olalde JA, Marfil A, Partida Medina LR, Gudi\u0026ntilde;o Castelazo M, et al. The burden of migraine in Mexico: a database analysis of migraine-related visits to emergency departments in Mexico\u0026rsquo;s Ministry of Health (MMoH) hospitals. Expert Rev Neurother. 2025 Apr 3;25(4):491\u0026ndash;500. \u003c/li\u003e\n\u003cli\u003eCaponnetto V, Deodato M, Robotti M, Koutsokera M, Pozzilli V, Galati C, et al. Comorbidities of primary headache disorders: a literature review with meta-analysis. J Headache Pain. 2021 Jul 14;22(1):71. \u003c/li\u003e\n\u003cli\u003eRossi MF, Tumminello A, Marconi M, Gualano MR, Santoro PE, Malorni W, et al. Sex and gender differences in migraines: a narrative review. Neurol Sci. 2022 Sep 1;43(9):5729\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eFriedman BW, Cisewski DH, Holden L, Bijur PE, Gallagher EJ. Age But Not Sex Is Associated With Efficacy and Adverse Events Following Administration of Intravenous Migraine Medication: An Analysis of a Clinical Trial Database. Headache J Head Face Pain. 2015 Nov 1;55(10):1342\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eRidolfi M, Granato A, Polverino P, Furlanis G, Ukmar M, Zorzenon I, et al. Migrainous aura as stroke-mimic: The role of perfusion-computed tomography. Clin Neurol Neurosurg. 2018 Mar 1;166:131\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eKelly AM, Kuan WS, Chu KH, Kinnear FB, Keijzers G, Karamercan MA, et al. Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)\u0026mdash;A multinational observational study. Headache J Head Face Pain. 2021 Nov 1;61(10):1539\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eVo P, Gao W, Zichlin ML, Fuqua E, Fadli E, Aguirre Vazquez M, et al. Migraine-related healthcare resource use in the emergency department setting: a panel-based chart review in France, Germany, Italy, and Spain. J Med Econ. 2019 Sep 2;22(9):960\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eDrangova H, Kofmel N, Branca M, Gloor D, Lehmann B, Exadaktylos A, et al. The potential to prevent unnecessary emergency department visits by timely diagnosis of migraine\u0026ndash;A prospective observational study. PLOS ONE. 2024 Oct 18;19(10):e0312106. \u003c/li\u003e\n\u003cli\u003eMinen MT, Loder E, Friedman B. Factors Associated With Emergency Department Visits for Migraine: An Observational Study. Headache J Head Face Pain. 2014 Nov 1;54(10):1611\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eWells S, Stiell IG, Vishnyakova E, Lun R, Nemnom MJ, Perry JJ. Optimal management strategies for primary headache in the emergency department. Can J Emerg Med. 2021 Nov 1;23(6):802\u0026ndash;11. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Assistance Publique – Hôpitaux de Paris","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"acute migraine attack, emergency department, combination therapy, pain relief, French recommendations","lastPublishedDoi":"10.21203/rs.3.rs-7964381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7964381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e To analyze the therapeutic management of patients consulting in the emergency department to relieve an acute migraine attack to determine whether it complied with the recommendations of the French Headache Society.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted an observational multicenter cohort prospective study. The patients included were adults (age ≥ 18 years) consulting in the emergency department (Lariboisière or Bichat Hospital) for the management of acute migraine attacks of moderate to severe intensity. The data was collected from October 1, 2021, to January 31, 2023. The primary endpoint was the proportion of patients reporting complete pain relief two hours after first-line treatment in the emergency department. Descriptive and stratified analyses of the data collected were performed. A logistic regression model was fitted to assess the association between complete relief and predictor variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Our sample included 178 patients. The median age was 33 years. Most patients were female (75%). To treat acute migraine attacks, 139 (78%) patients received first-line combination therapy. In most cases, this combination therapy included acetaminophen, metoclopramide, and clorazepate dipotassium. Triptans were administered to two patients. Seventy (45%) patients reported complete pain relief two hours after first-line treatment in the emergency department. Multivariate logistic regression identified age category [34–44] years as significantly associated with a higher probability of complete relief (OR = 10.1, 95% CI = 3.10–39.5, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The French therapeutic recommendations for the relief of acute migraine attacks were not sufficiently applied in two emergency departments.\u003c/p\u003e","manuscriptTitle":"Evaluation of the therapeutic management of patients who visit the emergency department for treatment of acute migraine attack","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 12:35:15","doi":"10.21203/rs.3.rs-7964381/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88aa2df0-918c-4ab5-b89f-98a4e2f32b4d","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56983666,"name":"Statistical Epidemiology"}],"tags":[],"updatedAt":"2025-10-29T12:35:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 12:35:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7964381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7964381","identity":"rs-7964381","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}