Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache

Perry, Jeffrey J.; Sivilotti, Marco L.A.; Sutherland, Jane; Hohl, Corinne M.; Émond, Marcel; Calder, Lisa A.; Vaillancourt, Christian; Thirganasambandamoorthy, Venkatesh; Lesiuk, Howard; Wells, George A.; Stiell, Ian G.

doi:10.1503/cmaj.170072

Cited by 59 publications

(62 citation statements)

References 20 publications

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“… This list of risk factors for serious pathology was informed from the following peer‐reviewed clinical practice guidelines rather than being developed from a systematic review of the literature on "red flags" (Carville et al, ; Duncan et al, ; Perry et al, ). …”

Section: Recommendationsmentioning

confidence: 99%

“…Clinicians may consider manual therapy (manipulation with or wit hout mobilization) to the cervical and thoracic spine limite d to a maximum of 10 sessions over six weeks. This recommendation is based on three low risk of bias RCTs suggesting that (a) spinal manipulation combined with light massage and moist heat (8 or 16 treatments over 8 weeks) is more effective than light massage and moist heat alone in improving headache pain, headache frequency and headache-induced disability (Haas, Schneider, & Vavrek, 2010;Haas, Spegman, Peters on, Aickin, & Vavrek, 2010); (b) spinal manipulation a nd mobilization (8-12 visits over 6 weeks) are more This list of risk factors for serious pathology was informed from the following peer-reviewed clinical practice guidelines rather than being developed from a systematic review of the literature on "red flags" (Carville et al, 2012;Duncan et al, 2008;Perry et al, 2017).…”

Section: Manual Therapymentioning

confidence: 99%

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Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration

Côté

Shearer

et al. 2019

European Journal of Pain

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Objectives To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic). Methods This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain. Results When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low‐load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension‐type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated. Conclusions Our evidence‐based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation. Significance Neck pain and headaches are very common comorbidities in the population. Tension‐type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension‐type and cervicogenic headaches should be patient‐centred.

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Section: Recommendationsmentioning

confidence: 99%

Section: Manual Therapymentioning

confidence: 99%

Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration

Côté

Shearer

et al. 2019

European Journal of Pain

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“…Moreover all groups had previously experienced similar TCH. Clinical guidelines have been developed for diagnosing SAH in patients presenting with acute headache with almost 100% sensitivity but poor specificity of 13.6% [26].…”

Section: Primary and Secondary Thunderclap Headachementioning

confidence: 99%

Other primary headaches—thunderclap-, cough-, exertional-, and sexual headache

Bahra

2020

J Neurol

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This article reviews the disorders of thunderclap, cough, exertional and sexual headache. These are a group of paroxysmal and precipitated headaches, which often occur in bouts with prolonged remissions. Indometacin seems to be the most effective preventative. Each can occur in primary and secondary form. Thunderclap headache is the most frequently reported headache syndrome associated with a secondary pathology. Discussed are the complexities of whether all patients with thunderclap headache should have further investigation if timely computerised tomography is normal and, the relevance of abnormal imaging in these disorders, differentiating what is deemed to be secondary and managing the pain.

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“…5 Thunderclap headache should always be investigated, and includes several differential diagnoses. 7 Specific inclusion and exclusion criteria limit its use. With a low suspicion of SAH, a good clinical judgment and a well-argued reason should underlie the decision of no further investigation of the patient.…”

mentioning

confidence: 99%

What is Currently the Best Investigational Approach to the Patient With Sudden‐Onset Severe Headache?

Sjulstad

Alstadhaug

2019

Headache

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A 48-year-old man with no previous medical history suddenly experienced severe intense retro-bulbar pain of pulsating character on the right side, and was seen in the emergency department 7 hours later. He was then alert and oriented, but in excruciating pain. There was no neck stiffness and no fever. The blood pressure was 141/80 mm Hg, and the pulse regular with a frequency of 48. Neurological examination was normal. Query by Dr. Sjulstad: When does actually sudden-onset severe headache represent a potential life-threatening condition?Response by Dr. Alstadhaug: There is no definite answer to that question. Atypical presentation of subarachnoid hemorrhage (SAH) with mild, or slowly progressive headache over minutes, and even absence of headache may occur in up to 3.8% of patients as reported in a recent Japanese study, 1 but previously up to 10% has been reported. 2 In a case series with 42 patients who had bled from an aneurysm, the headache came instantly in 50%, after 2-60 seconds in 24%, and within 1-5 minutes in 19%. 3 In 10%-40% of patients with diagnosed bleeding from an aneurysm, there has been an episode with hyperacute headache prior to the one that led to the diagnosis. 4 Such a warning leak has typically been reported to occur a couple of weeks earlier, but the risk of re-bleeding after SAH is highest within the first 24 hours. Non-ruptured aneurysms may also cause headache (dissection in the aneurysm wall, acute expansion or thrombosis), but more often they cause focal symptoms/signs due to mass effect Headache

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Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache

Cited by 59 publications

References 20 publications

Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration

Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration

Other primary headaches—thunderclap-, cough-, exertional-, and sexual headache

What is Currently the Best Investigational Approach to the Patient With Sudden‐Onset Severe Headache?

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