Migraine headaches affect 12% of the American population, incur $13 billion in annual direct and indirect costs, and cause the majority of the five million annual headache visits to American emergency departments (ED). In the American population, migraines are under-diagnosed and under-treated, particularly in lower socio-economic groups. Because an ED visit may be the migraine sufferer's first and only point of contact with the health care system, it represents an opportunity not only to treat a specific attack, but to engage the headache sufferer in an appropriate treatment program. Dr. Friedman will use the Award period to develop a foundation for a career focused on the ED diagnosis and treatment of headaches. Specifically, he will identify problematic areas in the ED management of migraines, determine who is at risk of poor outcomes after an ED visit for migraine, and conduct clinical trials to help define the optimal ED treatment of this disease. Eventually, this work will inform the development of evidence-based practice guidelines for the ED management of acute migraine headaches. Dr. Friedman will first conduct an observational cohort study in two EDs in the Bronx, NY. This study will classify all ED patients with non-traumatic headache and follow them for three months after their ED visit to determine if the presence of cutaneous allodynia or a high baseline disability score predicts poor pain and disability outcomes after ED discharge. Dr. Friedman will then conduct a clinical trial in the same two EDs to compare the efficacy of intramuscular trimethobenzamide to sumatriptan for acute migraine headaches. Trimethobenzamide has demonstrated good efficacy for acute migraines in preliminary data. In the latter years of the Award, the applicant will recruit other investigators and form an ED-based headache research network to conduct a series of headache trials in a standardized manner. The first clinical trial conducted by this research network will test the hypothesis that migraine sufferers treated with parenteral corticosteroids in addition to the standard of care will become headache pain-free more rapidly after ED treatment than those patients treated with placebo plus standard of care. By the end of the Award period, Dr. Friedman will apply for independent funding to use this ED-based research network to develop and validate comprehensive headache guidelines to optimize ED diagnosis and treatment of acute migraines and other primary headache disorders. ? ? ?

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
Application #
Study Section
NST-2 Subcommittee (NST)
Program Officer
Porter, Linda L
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Budget Start
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Fiscal Year
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Montefiore Medical Center (Bronx, NY)
New York
United States
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Minen, Mia T; Loder, Elizabeth; Friedman, Benjamin (2014) Factors associated with emergency department visits for migraine: an observational study. Headache 54:1611-8
Friedman, Benjamin W; Mulvey, Laura; Davitt, Michelle et al. (2012) Predicting 7-day and 3-month functional outcomes after an ED visit for acute nontraumatic low back pain. Am J Emerg Med 30:1852-9
Friedman, Benjamin W; Solorzano, Clemencia; Norton, Jennifer et al. (2012) A randomized controlled trial of a comprehensive migraine intervention prior to discharge from an emergency department. Acad Emerg Med 19:1151-7
Diener, Hans-Christoph; Dodick, David W; Goadsby, Peter J et al. (2011) Chronic migraine--classification, characteristics and treatment. Nat Rev Neurol 8:162-71
Friedman, Benjamin W; Mulvey, Laura; Esses, David et al. (2011) Metoclopramide for acute migraine: a dose-finding randomized clinical trial. Ann Emerg Med 57:475-82.e1
Friedman, Benjamin W; Bijur, Polly E; Lipton, Richard B (2010) Standardizing emergency department-based migraine research: an analysis of commonly used clinical trial outcome measures. Acad Emerg Med 17:72-9
Friedman, Benjamin W; Solorzano, Clemencia; Esses, David et al. (2010) Treating headache recurrence after emergency department discharge: a randomized controlled trial of naproxen versus sumatriptan. Ann Emerg Med 56:7-17
Kister, Ilya; Caminero, A B; Monteith, T S et al. (2010) Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain 11:417-25
Friedman, Benjamin W; Chilstrom, Mikaela; Bijur, Polly E et al. (2010) Diagnostic testing and treatment of low back pain in United States emergency departments: a national perspective. Spine (Phila Pa 1976) 35:E1406-11
Friedman, Benjamin W; Serrano, Daniel; Reed, Michael et al. (2009) Use of the emergency department for severe headache. A population-based study. Headache 49:21-30

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