We compared treatment of patients with episodic, severe, migraine-vascular headaches in three outpatient settings associated with a major medical center: the Charlton Outpatient Therapy Center (COTC), a dedicated transfusion and injection facility which provides treatment based on physician orders written in advance of the patient's visit; a walk-in Urgent Care Center (UCC); and a traditional hospital emergency trauma unit (ETU). For a 7-month period in 1995, all patient visits for acute migraine headache to the COTC, UCC, and ETU were reviewed. Data collected included the treatment and charges. After the study period, a sample of patients was surveyed regarding their outcome and satisfaction with care at each of the three facilities. During the study period, 15 patients visited the COTC 446 times for the treatment of acute migraine, 80 patients visited the UCC 233 times, and 182 patients visited the ETU 238 times. The average charges per visit were $39.93 for the COTC, $57.28 for the UCC, and $317.71 for the ETU. Average time spent in order to obtain care was 35 minutes in the COTC, 62 minutes in the UCC, and 105 minutes in the ETU. Intramuscular meperidine with either promethazine or hydroxyzine was the most commonly administered treatment in all three settings. Patients treated in the COTC reported greater satisfaction than the patients seen in the UCC or ETU. A dedicated outpatient facility with extended hours of operation and the capability of treating acute headache patients with parenteral medications based on standing orders has provided a community of migraine sufferers with cost-effective care.