Epidemiology of intravenous fluid use for headache treatment: Findings from the National Hospital Ambulatory Medical Care Survey

Background: Headache is one of the most common reasons for patients to seek care in emergency departments. While the administration of intravenous fluids is frequently recommended for emergency department patients with migraine, the epidemiology of the use of this intervention is unknown.

Objectives: To describe the epidemiology of intravenous fluid use in emergency department patients with headache.

Methods: This retrospective study utilized the 2011 US National Hospital Ambulatory Medical Survey, a multi-stage weighted survey providing nationally representative estimates of ED visits. Patients with chief complaints of non-traumatic headache or migraine headache were included. We determined the frequency of intravenous fluid administration among patients presenting with headache, and among specific subgroups including those with migraine headache.

Results: There were 1251 sample cases representing 5,981,000 visits for a chief complaint of headache. Intravenous fluids were administered at 40% (95% CI 35-44%) of these visits. Among the 222 migraine cases, 47% (95% CI 39-56%) received fluids. Fluids were commonly administered regardless of pain severity, and fluid administration was not significantly associated with pain severity among patients diagnosed with migraine (p=0.39). After adjusting for patient characteristics, ED visit duration remained greater for patients receiving fluids than for those who did not among both patients with a headache complaint and among those with a diagnosis of migraine headache.

Conclusions: Despite a lack of efficacy data, patients treated in United States EDs for headache frequently receive IV fluids. Studies are needed to determine the efficacy of this basic treatment intervention.