Rapid referral for headache management from Emergency Department to Headache Centre: four years data

Abstract

Background Headache is one of the most common reason for medical consultation to emergency department (ED). Inappropriate use of ED for non-urgent conditions is a problem in terms of crowding emergency facilities, unnecessary testing and treatment, increased medical bills, burden on medical service providers and weaker patient-primary care provider relationships. The aim of this study was to analyzed the different steps of the ED management of patients with headache to detect those deficiencies that can be overcome by a prompt referral to a headache clinic.Methods The study is a retrospective analysis of the electronic medical records (EMRs) of patients discharged from an academic ED between 1 January 2015 and 31 December 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all the aspects related to the permanence in ED and we also assessed if there was a concordance between ED diagnosis and ours.Results Among our sample of 244 patients, 76.2% were admitted as green tag, 75% underwent a head computed tomography, 19.3% received neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. Length in ED stay was associated with the complaint of the first aura ever (p = 0.014) and if patients received consultations (p < 0.001). Concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.Conclusions The majority of patients who went to the ED complaining of headache received the same therapy regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the several shortcomings of ED management of headaches, a rapid referral to the headache centre is of primary importance to help the patient obtain a definite diagnosis and adequate treatment.

Deprescribing in migraine

“…Furthermore, in case of ineffectiveness or intolerable side effects of the preventive co-prescription, patients tend to inappropriately crowd the Emergency Department, from where they are discharged with a still ongoing headache (37.3%), having been confirmed clinically or by imaging the absence of a secondary red-flag headache, but unfortunately carrying out a different co-prescription of 2 acute drugs in 10.2% of cases, or three in 1.2% of cases, and thus perpetuating this vicious circle [7].…”

Unmet needs for migraine

“…Many studies have been undertaken to define the critical issues relating to incorrect migraine management, from the completely avoidable costs of migraine derived from access and its management in the Emergency Departments 19,20 , from Healthcare Resource Use (HRU) and indirect costs 21 , from the impact of migraine disease on workplace productivity and related monetary loss 14,22 , from the underestimation of the binomial spontaneous progression towards chronicity/ resistance/refractoriness with secondary appearance of psychiatric comorbidity 23,24 .…”

A Review on Classification, Pathophysiology, Diagnosis, and Pharmacotherapy of Headache

“…The non-pharmacological therapy is also used in the preventive headache treatment. In addition to pharmacological therapy, lifestyle changes help in treating headaches [44]. Many non-drug techniques are available that can reduce or prevent head pain, such as massage, applying cold or heat packs, and avoiding the triggers of headache.…”