Documented pain relief after emergency department headache treatment is not a stable outcome.
Documented Pain Relief After Emergency Department Headache Treatment Is Not a Stable Outcome: Reassessment Timing, Missingness, and Score Selection
Among 19,501 visits (15,273 patients), 13,682 (70.2%) were treated.
A post-treatment pain score appeared at any time for 77.1% (95% CI, 76.4 to 77.8), but within 2 hours of the analgesic for only 47.9% and within 1 hour for 27.5%.
Completeness was similar across headache strata and comparator painful presentations.
In an independent ED (MC-MED, a different EHR), the score-selection effect replicated: relief rose from 71.1% (first) to 80.6% (last) and 83.4% (lowest).
Documented pain relief after ED headache treatment was not a stable outcome: it varied with the reassessment window and score-selection rule, was not point-identified for unreassessed patients, and behaved like other painful ED presentations.
Programs and research that use documented relief should prespecify the reassessment window, score-selection rule, completeness denominator, and a missing-data range, and favor protocol-timed reassessment.