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The Journal of Headache and Pain
Published in: The Journal of Headache and Pain 1/2017

Open Access 01-12-2017 | Research article

Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

Authors: Claudine Angela Blum, Bettina Winzeler, Nicole Nigro, Philipp Schuetz, Silke Biethahn, Timo Kahles, Cornelia Mueller, Katharina Timper, Katharina Haaf, Janina Tepperberg, Margareth Amort, Andreas Huber, Roland Bingisser, Peter Stephan Sándor, Krassen Nedeltchev, Beat Müller, Mira Katan, Mirjam Christ-Crain

Published in: The Journal of Headache and Pain | Issue 1/2017

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Abstract

Background

In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out.
Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.

Methods

Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.

Results

Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52–2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63–0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26–2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001).
Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.

Conclusions

Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.

Trial registration

Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov.
Appendix
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Metadata
Title
Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study
Authors
Claudine Angela Blum
Bettina Winzeler
Nicole Nigro
Philipp Schuetz
Silke Biethahn
Timo Kahles
Cornelia Mueller
Katharina Timper
Katharina Haaf
Janina Tepperberg
Margareth Amort
Andreas Huber
Roland Bingisser
Peter Stephan Sándor
Krassen Nedeltchev
Beat Müller
Mira Katan
Mirjam Christ-Crain
Publication date
01-12-2017
Publisher
Springer Milan
Published in
The Journal of Headache and Pain / Issue 1/2017
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI
https://doi.org/10.1186/s10194-017-0733-2

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