Conference Coverage

Algorithm-Driven Migraine Care in the Emergency Department Cuts Opioid Use, Hospital Admissions

Edited by:
Anthony Calabro, MA

Key Highlights:

  • Guideline-based migraine treatment in the emergency department (ED) improved from 74% to 88% after algorithm implementation.
  • Opioid use for migraine decreased from 26% to 12%.
  • Hospital admissions for unresolved migraine were reduced by 50%.
  • No patients returned to the ED for migraine treatment post-implementation.

A retrospective analysis conducted at Baptist Hospital of Miami (BHM) evaluated the impact of an evidence-based algorithm on acute migraine management in the emergency department. The study, presented at the 2025 American Society of Health-System Pharmacists Midyear Clinical Meeting in Las Vegas, NV, highlights improvements in treatment consistency and reductions in opioid use following the intervention.

Investigators conducted a single-site retrospective chart review comparing care delivered before and after implementation of an evidence-based migraine treatment algorithm. Emergency department clinicians were educated on the algorithm, and 100 adult patients presenting with migraine between January and April 2025 were included, with 50 patients in each study arm. Pregnant patients were excluded. The primary outcome was adherence to guideline-recommended migraine therapy. Secondary outcomes included opioid exposure, admission rates without migraine abortion, and ED re-presentation.

Study Findings

Following implementation, adherence to evidence-based migraine treatment increased from 74% to 88%. Commonly used medications included intravenous fluids, antiemetics, and non-opioid analgesics. Opioid use decreased substantially, from 26% pre-intervention to 12% post-intervention, reflecting more consistent application of recommended therapies.

Hospital admissions due to unresolved migraine decreased by 50%, and no patients in the post-intervention group returned to the ED seeking additional migraine treatment. These improvements suggest that structured, evidence-based treatment pathways may enhance the effectiveness and efficiency of ED migraine care.

Clinical Implications

According to the study authors, the findings indicate that a straightforward, evidence-based treatment algorithm can optimize migraine management in emergency settings. They noted that reducing unnecessary opioid use and improving guideline adherence may contribute to better patient outcomes and lower resource utilization. The authors also noted several limitations, including the small sample size, generalizability of findings, the subjectivity of patient-reported pain severity, and the study’s inability to capture re-admissions to other healthcare facilities.

Expert Commentary

“Future directions include developing an ED migraine treatment order set utilizing the treatment algorithm, emphasizing ‘treat to street’ migraine care in the ED and, assessing inpatient prescribing trends for migraine management,” the researchers concluded.

Reference

Porben Guzman L, Dittmar E, Wolfel T, Justiz J, Vargas A. Evaluation of migraine treatment in the emergency department. Paper presented at: ASHP Midyear Clinical Meeting; December 7-10, 2025; Las Vegas, NV. Accessed December 05, 2025. https://midyear2025.eventscribe.net/index.asp.