ORIGINAL RESEARCH CONTRIBUTION A Randomized Controlled Trial of a Comprehensive Migraine Intervention Prior to Discharge From an Emergency Department Benjamin W. Friedman, MD, MS, Clemencia Solorzano, DrPh, Jennifer Norton, DO, Victoria Adewumni, MD, Caron M. Campbell, MD, David Esses, MD, Polly E. Bijur, PhD, Seymour Solomon, MD, Richard B. Lipton, MD, and E. John Gallagher, MD Abstract Objectives: Patients who use an emergency department (ED) for acute migraine headaches have higher migraine disability scores, lower socioeconomic status, and are unlikely to have used a migraine- specific medication prior to presentation to the ED. The objective was to determine if a comprehensive migraine intervention, delivered just prior to ED discharge, could improve migraine impact scores 1 month after the ED visit. Methods: This was a randomized controlled trial of a comprehensive migraine intervention versus typical care among patients who presented to an ED for management of acute migraine. At the time of discharge, for patients randomized to comprehensive care, the research team reinforced their diagnosis, shared a migraine education presentation from the National Library of Medicine, provided them with six tablets of sumatriptan 100 mg and 14 tablets of naproxen 500 mg, and if they wished, provided them with an expe- dited free appointment to the institution’s headache clinic. Patients randomized to typical care received the care their attending emergency physicians (EPs) felt was appropriate. The primary outcome was a between-group comparison of the Headache Impact Test (HIT-6) score, a validated headache assessment instrument, 1 month after ED discharge. Secondary outcomes included an assessment of satisfaction with headache care and use of migraine-specific medication within that 1-month period. Results: Over a 19-month period, 50 migraine patients were enrolled. One-month follow-up was success- fully obtained in 92% of patients. Baseline characteristics were comparable. One-month HIT-6 scores in the two groups were nearly identical (59 vs. 56, 95% confidence interval [CI] for difference of 3 = )5 to 11), as was dissatisfaction with overall headache care (17% vs. 18%, 95% CI for difference of 1% = )22% to 24%). Patients randomized to the comprehensive intervention were more likely to be using triptans or migraine-specific therapy (43% vs. 0%, 95% CI for difference of 43% = 20 to 63%) 1 month later. Conclusions: A comprehensive migraine intervention, when compared to typical care, did not improve HIT-6 scores (a validated measure of the effect of migraine on one’s daily life) 1 month after ED dis- charge. Future work is needed to define a migraine intervention that is practical and useful in an ED, where many underserved patients, of necessity, present for care. ACADEMIC EMERGENCY MEDICINE 2012; 19:000–000 ª 2012 by the Society for Academic Emergency Medicine ª 2012 by the Society for Academic Emergency Medicine ISSN 1069-6563 doi: 10.1111/j.1553-2712.2012.01458.x PII ISSN 1069-6563583 1 From the Department of Emergency Medicine, Albert Einstein College of Medicine (BWF, JN, VA, CMC, DE, PEB, EJG), Bronx, NY; and the Pharmacy Department (CS) and the Department of Neurology and Montefiore Headache Center (SS, RBL), Montefi- ore Medical Center, Albert Einstein College of Medicine, Bronx, NY. Received March 23, 2012; revision received April 13, 2012; accepted May 8, 2012. Some of this research was conducted with Dr. Friedman’s K23 Career Develoment Award from the National Institute of Neurological Disorders and Stroke 1K23NS051409. The authors have no relevant financial information or potential conflicts of interest to disclose. Supervising Editor: Steven B. Bird, MD. Address for correspondence and reprints: Benjamin W. Friedman, MD, MS; e-mail: befriedm@montefiore.org.