Treatment of Primary Headache in the Emergency Department

Blumenthal, Harvey J.; Weisz, Michael; Kelly, Karen; Mayer, Renae L; Blonsky, Jeffrey

doi:10.1046/j.1526-4610.2003.03202.x

Cited by 69 publications

(78 citation statements)

References 11 publications

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Section: Prevalencementioning

confidence: 99%

“…The prevalence of migraine diagnosis at discharge from emergency is very variable, ranging from 15 to 32% [3,8,9]. The majority of patients were discharged with a diagnosis of cephalalgia or headache not otherwise specified (NOS) [3,8,9]. J Headache Pain (2005) Abstract Headache is one of the most common reported complaints in the general adult population and it accounts for between 1% and 3% of admissions to an Emergency Department (ED).…”

Section: Prevalencementioning

confidence: 99%

“…As mentioned before, we have just showed there are no clear epidemiological data on the prevalence of headache in the ED. Migraine represents the most prevalent disabling form of PH in the general population and is the most prevalent form of headache also in the ED [3,8,9].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Despite the availability of criteria and effective therapies for the treatment of migraines, in emergency the use of different non-specific drugs is possible, a so-called "migraine cocktail", which permits relief of pain but not a complete return to normal function at the time of discharge [9].…”

Section: Therapeutical Approachmentioning

confidence: 99%

“…This is because most of the data collected in this field are obtained with retrospective studies. From this point of view it has been shown that the incidence of primary headache (PH) diagnosis is lower in the ED than in the general population [1][2][3][4][5][6][7][8][9].In a multicentre retrospective Italian study [3] done to evaluate the prevalence of primary headache in the ED, it accounted for 0.6% of all attendances. In an observational three-month pilot study, executed by our team in 2002, we found a prevalence of 1.2% of headache complaints in the ED (unpublished data).…”

mentioning

confidence: 99%

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Primary headache in Emergency Department: prevalence, clinical features and therapeutical approach

et al. 2005

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PrevalenceHeadache is one of the most common reported complaints in the general adult population and it accounts for between 1% and 3% of admissions to emergency departments (ED) [1,2]. Despite the fact that this symptom is very widespread and is a costly medical condition, the diagnosis of headache and its epidemiological impact in the ED has still not been completely considered. This is because most of the data collected in this field are obtained with retrospective studies. From this point of view it has been shown that the incidence of primary headache (PH) diagnosis is lower in the ED than in the general population [1][2][3][4][5][6][7][8][9].In a multicentre retrospective Italian study [3] done to evaluate the prevalence of primary headache in the ED, it accounted for 0.6% of all attendances. In an observational three-month pilot study, executed by our team in 2002, we found a prevalence of 1.2% of headache complaints in the ED (unpublished data).An unexpected aspect of the data obtained in our study was the equal prevalence of secondary (52%) and primary (48%) headache in this population.Out of PH, migraine headache is a common presenting complaint to the ED. The prevalence of migraine diagnosis at discharge from emergency is very variable, ranging from 15 to 32% [3,8,9]. The majority of patients were discharged with a diagnosis of cephalalgia or headache not otherwise specified (NOS) [3,8,9]. J Headache Pain (2005) Abstract Headache is one of the most common reported complaints in the general adult population and it accounts for between 1% and 3% of admissions to an Emergency Department (ED). The overwhelming majority of patients who present to an ED with acute primary headache (PH) have migraine and very few of them receive a specific diagnosis and then an appropriate treatment. This is due, in part, to a low likelihood of emergency physicians diagnosing the type of PH, in turn due to lack of knowledge of the IHS criteria, and also the clinical condition of the patients (pain, border type of headache, etc.) In agreement with the literature, another interesting aspect of data emerging from our experience is that few of the ED PH patients are referred to headache clinics for diagnosis and treatment, especially if they present with high levels of disability. This attitude promotes the high-cost phenomenon of repeater patients that have already been admitted to the ED for the same reason in the past. This is statistically important because it involves about 10% of the population with PH.6:287-289 DOI 10.1007/s10194-005-0210-1 Primary headache in Emergency Department: prevalence, clinical features and therapeutical approach

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Section: Prevalencementioning

confidence: 99%

Section: Prevalencementioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Therapeutical Approachmentioning

confidence: 99%

mentioning

confidence: 99%

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Primary headache in Emergency Department: prevalence, clinical features and therapeutical approach

et al. 2005

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Therapeutic Agents for the Treatment of Migraine

Dubowchik¹,

Macor²

2010

Burger's Medicinal Chemistry and Drug Discovery

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Migraine is a debilitating condition, often with nearly unbearable throbbing pain, nausea, and greatly reduced thresholds to sensory stimulation. Despite the availability of specific acute medications (such as triptans), for over 15 years, migraine remains an undertreated condition. Although representing a revolution in headache therapy at the time, triptans have a number of shortcomings including cardiovascular side effects resulting from their inherent vasoconstrictive properties, and a significant proportion of refractory patients. CGRP antagonists appear to represent the next revolution in migraine therapy, with clinical safety issues shown to be comparable to placebo and 2 h response rates identical to the triptans. Preventative migraine therapy has been dominated by older drugs developed for other indications such as hypertension, epilepsy, and depression. These agents often have significant side effects. Drugs that act on other relevant mechanisms such as ion channels and nitric oxide generation have been developed and tested in the clinic. These have yet to emerge as rivals to the triptans. However, the pathophysiology of migraine is complex and combination therapies that target multiple mechanisms, including one or more of these, may turn out to be more efficacious than monotherapy. An important aspect of migraine therapy that has been addressed with only partial success is speed of onset. Intranasal and pulmonary delivery offer the potential for more rapid systemic exposure and perhaps faster onset of efficacy. Migraine patients are in particular need of improved nonoral drug delivery systems that can provide rapid relief of headache pain along with associated symptoms.

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