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Adherence to guidelines of treatment of non-traumatic headache in the emergency department

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Abstract

To evaluate therapies employed in patients presenting to the emergency department (ED) with a chief complaint of non-traumatic headache to check if guidelines are followed. A 6-month retrospective analysis of the ED records of all the patients who referred to the ED of the University Hospital of Trieste for non-traumatic headache was performed. Out of 37.335 admissions, 336 patients were selected (0.9%). Diagnosis at discharge was primary headache (25.6%), secondary headache (40.5%), and headache “not otherwise specified” (33.9%). One-hundred-ninety-three patients were treated in mono- (51.8%) or poly-therapy (48.2%), with NSAIDs (46.5%), benzodiazepines (13.4%), antiemetics (10.7%), analgesics (8.3%), opioids (1.6%), triptans (1.5%), and other drugs (17.7%). NSAIDs, particularly ketorolac, are the class of drugs most often prescribed in ED, independently of the discharge diagnosis. Metoclopramide is rarely used in monotherapy (4%), but it is the drug most frequently used in association with NSAIDs (19.3%). Only two migraineurs received triptans. Mean time spent in ED was 231 ± 130 min, which was significantly longer in patients who received treatment (272 ± 141 vs. 177 ± 122 min; p = 0.003). No drugs had any side effects. In accordance with the current guidelines, NSAIDs monotherapy or in association with antiemetics were the drugs most often prescribed in ED. Opioids were rarely used probably because of potential sedative side effects. Only very few patients received triptans. Special attention should be drawn also in ED to apply the International Classification of Headache Disorders criteria, which can lead to clarify the diagnosis and receive the specific treatment.

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Authors and Affiliations

  1. Department of Experimental and Clinical Medicine and Experimental and Clinical Neurosciences, Neurological Clinic, Headache Center, University Hospital of Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    Antonio Granato, Maria Elisa Morelli, Laura D’Acunto & Paolo Manganotti

  2. Emergency Department, University Hospital of Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    Franco Cominotto

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  1. Antonio Granato
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  2. Maria Elisa Morelli
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  3. Franco Cominotto
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  4. Laura D’Acunto
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  5. Paolo Manganotti
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AG and MEM. The first draft of the manuscript was written by AG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Antonio Granato declares that he has no conflict of interest. Maria Elisa Morelli declares that she has no conflict of interest. Franco Cominotto declares that he has no conflict of interest. Laura D’Acunto declares that she has no conflict of interest. Paolo Manganotti declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Granato, A., Morelli, M., Cominotto, F. et al. Adherence to guidelines of treatment of non-traumatic headache in the emergency department. Acta Neurol Belg 120, 19–24 (2020). https://doi.org/10.1007/s13760-020-01272-y

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  • DOI: https://doi.org/10.1007/s13760-020-01272-y

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