The objective of this study was to describe the characteristics and clinical course of patients who receive emergency department (ED) migraine treatment and their association with frequent ED visits. All migraine patient records during a 42-month period were reviewed retrospectively at an urban teaching hospital ED. One hundred eighty-five migraine patients had 339 total visits; 133 had a single visit; 31 had two visits; and 21 patients had three or more ED visits (range, 3 to 26 visits). Patients with three or more visits accounted for 42.5% of all ED migraine visits. Drugs were administered in 82.3%, and efficacy was documented in 49% of ED visits. Complete or considerable relief was noted in 64.5% of visits. Drug abuse was infrequently identified in migraine patients. Most migraine patients seem to use the ED appropriately. A small group (11.4%) of patients accounted for 42.5% of all ED visits. Given the nature of severe, frequent migraines and the current lack of consistently effective therapy, this may be a common ED phenomenon. More effective management strategies and therapy that will enable patients to reduce their dependence on the ED for treatment would be useful for patients with multiple ED visits.