Headache in the Emergency Department

Raam, Ryan; Tabatabai, Ramin

doi:10.1016/j.emc.2020.09.004

Cited by 7 publications

(3 citation statements)

References 110 publications

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“…The majority of patients admitted to the ED with headache are diagnosed with a benign primary headache disorder. Nevertheless, about 10% of headache patients are diagnosed with severe secondary headache disorders including trauma, hemorrhage, vascular pathology, infection, or malignancy ( 5 – 7 ). Clinical clues for secondary headache causes can be obtained from vital signs and extensive neurological examination; however, these may be absent in a substantial amount of patients with intracranial pathology.…”

Section: Introductionmentioning

confidence: 99%

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

2021

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Background: Headache is among the most prevalent complaints in patients presenting to the emergency department (ED). Clinicians are faced with the difficult task to differentiate primary (benign) from secondary headache disorders, since no international guidelines currently exist of clinical indicators for neuroimaging in headache patients.Methods: We performed a retrospective review of 501 patients who presented at the ED with headache as a primary complaint between April 2018 and December 2018. Primary outcomes included the amount of diagnostic imaging, the different conclusions provided by diagnostic imaging, and the clinical factors associated with abnormal imaging results.Results: About half of the patients were diagnosed with a primary headache disorder. Cranial CT imaging at the ED was performed regularly (61% of the patients) and led to the diagnosis of underlying pathology in 1 in 7.6 patients. In a multivariate model, factors significantly associated with abnormal cranial CT results were age 50 years or older, presentation within 1 h after headache onset, clinical history of aphasia, and focal neurological deficit at examination.Conclusions: As separate clinical characteristics have limited value in detecting severe underlying headache disorders, cranial imaging is regularly performed in the ED. Clinical prediction model tools applied to headache patients may identify patients at risk of intracranial pathology prior to diagnostic imaging and reduce cranial imaging in the future.

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Section: Introductionmentioning

confidence: 99%

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

2021

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“…There are many varying types and underlying etiologies of primary and secondary headaches. Although most ED patients have benign primary headaches (e.g., migraine, tension-type, cluster), differentiating from emergency and life-threatening conditions like hemorrhage or ischemic strokes, intracranial infections, tumors, and toxicities are of the utmost priority in the ED [ 5 ]. Several national clinical policies and guidelines for assessment and treatment of headache in the ED are available [ 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Headache in the Emergency Department: A Multicenter Observational Study from Singapore

et al. 2023

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Background and Objectives: There is scarce data about the epidemiology, clinical features, investigations, diagnosis, treatment, and outcome in patients attending Singapore emergency departments (EDs) with nontraumatic headache. We sought to describe these characteristics of adult patients presenting to the ED with a primary complaint of headache. Materials and Methods: We performed a cross-sectional study on adult patients with nontraumatic headache over 4 consecutive weeks from 18 March 2019 to 14 April 2019 across four EDs in Singapore. Exclusion criteria were history of head trauma within 48 h of presentation, missing records, interhospital transfers, representation with the same headache as a recent previous visit and headache as an associated symptom. Results: During the study period, 579 patients (representing 1.8% of the total ED census) comprising 55.3% males and with a median age of 36 years presented to the four Singapore EDs with a primary complaint of nontraumatic headache. Paracetamol (41.5%), non-steroidal anti-inflammatory drugs (34.4%) and tramadol (31.5%) were the three commonest analgesics used either singly or in combination. Prochlorperazine (22.9%) and metoclopramide (17.4%) were frequent anti-emetic adjuncts. One-third of patients had computed tomography of the brain performed, which found abnormalities among 20.9% of them. ED diagnoses of primary headache conditions were made in 73.6% of patients. Conclusions: Primary headaches constituted most ED headache diagnoses. ED imaging of selected patients yielded a relatively high pick-up rate for significant intracranial abnormalities. Opioid use for symptomatic relief of headaches in the ED was found to be high, underscoring the need for improvement in headache analgesia relief practices in the ED.

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“…Therefore, proper medical evaluation and management is essential. A clinician must be able to determine the underlying cause, through a detailed history and physical examination [6,7].…”

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confidence: 99%

Pain or Pressure? Delineating between Primary and Secondary Headache

Davis Jr.,

Desai,

Malafi

2023

Preprint

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Headache is considered to be one of the most common causes of medical treatment and evaluation worldwide in both acute and outpatient settings. It is the most common neurological symptom seen worldwide affecting all genders, ages, ethnicities, and socioeconomic levels. It’s impact is noted in educational decline in school-aged children and decreased productivity through sick leave in adults. Its overall burden is well documented in well-resourced countries but limited data is seen low resourced countries. While many underlying causes bring about secondary headaches, primary headaches and more specifically migraines have been more widely explored. Migraines have a distinct criterion that is inclusive of one day duration (4 hours to 7 days, unilateral distribution, nausea and vomiting and disability as a few examples. However, migraines can vary and proper documentation through a migraine diary can help to guide treatment. Management of migraines can vary. Lifestyle modification is a key factor in the overall prevention and reduction of triggers in migraines. In addition to this, pharmacotherapy can be given in a tier-based approach based on overall severity and frequency of the migraine. Interventions have progressed from botox injection and have seen the advent of new medications such as nasal sprays to novel formulations of pre-existing drug formulations. Nonetheless, there is great room for further studies of headaches and migraines. Research specifically in low-resource countries can prove to beneficial.

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Headache in the Emergency Department

Cited by 7 publications

References 110 publications

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

Headache in the Emergency Department: A Multicenter Observational Study from Singapore

Pain or Pressure? Delineating between Primary and Secondary Headache

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