Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
The Journal of Headache and Pain
Published in: The Journal of Headache and Pain 1/2019

Open Access 01-12-2019 | Migraine | Research article

Headaches in the emergency department –a survey of patients’ characteristics, facts and needs

Authors: Alberto Doretti, Irina Shestaritc, Daniela Ungaro, John-Ih Lee, Loukas Lymperopoulos, Lili Kokoti, Martina Guglielmetti, Dimos Dimitrios Mitsikostas, Christian Lampl, on behalf of the School of Advanced Studies of the European Headache Federation (EHF-SAS)

Published in: The Journal of Headache and Pain | Issue 1/2019

Login to get access

Abstract

Background and aim

Headache is very often the cause for seeking an emergency department (ED). However, less is known about the different diagnosis of headache disorders in the ED, their management and treatment. The aim of this survey is to analyse the management of headache patients in two different ED in Europe.

Methods

This retrospective survey was performed from September 2018 until January 2019. Patients were collected from the San Luca Hospital, Milan, Italy and the Ordensklinikum Barmherzige Schwestern, Linz, Austria. Only patients with a non-traumatic headache, as the primary reason for medical clarification, were included. Patients were analysed for their complexity and range of examination, their diagnoses, acute treatment and overall efficacy rate.

Results

The survey consists of 415 patients, with a mean age of 43.32 (SD ±17.72); 65% were female. Technical investigation was performed in 57.8% of patients. For acute treatment non-steroidal-anti-inflammatory drugs (NSAIDs) were the most used, whereas triptans were not given. A primary headache disorder was diagnosed in 45.3% of patients, being migraine the most common, but in 32% of cases the diagnosis was not further specified. Life-threatening secondary headaches accounted for less than 2% of cases.

Conclusions

The vast majority of patients attending an ED because of headache are suffering from a primary headache disorder. Life-threatening secondary headaches are rare but seek attention. NSAIDs are by far the most common drugs for treating headaches in the ED, but not triptans.
Literature
1.
Locker T, Mason S, Rigby A (2204) Headache management—are we doing enough? An observational study of patients presenting with headache to the emergency department. Emerg Med J 21:327–332CrossRef
2.
Leicht MJ (1980) Non-traumatic headache in the emergency department. Ann Emerg Med 9:404–409CrossRef
3.
Ramirez-Lassepas M, Espinosa CE, Cicero JJ, Johnston KL, Cipolle RJ, Barber DL (1997) Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol 54:1506–1509CrossRef
4.
Barton CW (1994) Evaluation and treatment of headache patients in the emergency department: a survey. Headache 34:91–49CrossRef
5.
Mitsikostas DD, Ashina M, Craven A, Diener HC, Goadsby PJ, Ferrari MD, Lampl C, Paemeleire K, Pascual J, Siva A, Olesen J, Osipova V, Martelletti P, on behalf of EHF (2016) European headache federation consensus on technical investigation for primary headache disorders. J Headache Pain 17:5CrossRef
6.
Goldstein JN, Camargo CA Jr, Pelletier AJ, Edlow JA (2006) Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia 26(6):684–690CrossRef
7.
Tabatabai RR, Swadron SP (2016) Headache in the emergency department: avoiding misdiagnosis of dangerous secondary causes. Emerg Med Clin North Am 34:695CrossRef
8.
Headache Classification Committee of the International Headache Society (IHS) (2018) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38(1):1–211CrossRef
9.
Lipton RB, Stewart WF, Simon D (1998) Medical consultation for migraine: results from the American migraine study. Headache 38:87–96CrossRef
10.
Chu KH, Howell TE, Keijzers G, Furyk JS, Eley RM, Kinnear FB, Thom O, Mahmoud I, Brown AF (2017) Acute headache presentations to the emergency department: a state wide cross-sectional study. Acad Emerg Med 24(1):53–62CrossRef
11.
Bigal M, Bordini CA, Speciali JG (2000) Headache in an emergency room in Brazil. Sao Paulo Med J/Rev Paul Med 118(3):58–62CrossRef
12.
Friedman Friedman BW, Hochberg ML, Esses D, Grosberg B, Corbo J, Toosi B, Meyer RH, Bijur PE, Lipton RB, Gallagher EJ (2007) Applying the international classification of headache disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Ann Emerg Med 49:409–419CrossRef
13.
Friedman BW, West J, Vinson DR, Minen MT, Restivo A, Gallagher AJ (2015) Current management of migraine in US emergency departments: An analysis of the National Hospital Ambulatory Medical Care Survey. Cephalalgia 35(4):301–309CrossRef
14.
Do TP, Remmers A, Schytz HW, Schankin C, Nelson SE, Obermann M, Hansen JM, Sinclair AJ, Gantenbein AR, Schoonman GG (2019) Red and orange flags for secondary headaches in clinical practice: SNNOOP 10 list. Neurology 92(3):134–144CrossRef
15.
Cortelli P, Cevoli S, Nonino F, Baronciani D, Magrini N, Re G, De Berti G, Manzoni GC, Querzani P, Vandelli A, Multidisciplinary Group for Nontraumatic headache in the Emergency Department (2004) Evidence-Based Diagnosis of Nontraumatic in the Emergency Department: a Consensus Statement on Four Clinical Scenarios. Headache 44:587–559CrossRef
16.
Barton C (1993) Evaluation and treatment of headache patients in the emergency department: a survey. Headache 34:91–94CrossRef
17.
Friedman BW, Grosberg BM (2009) Diagnosis and management of the primary headache disorders in the emergency department setting. Emerg Med Clin North Am 27:71–87CrossRef
18.
Nye BL, Ward TN (2015) Clinic and emergency room evaluation and testing of headache. Headache 55(9):1301–1308CrossRef
19.
Levin M (2015) Approach to the workup and Management of Headache in the emergency department and inpatient settings. Semin Neurol 35(6):667–674CrossRef
Metadata
Title
Headaches in the emergency department –a survey of patients’ characteristics, facts and needs
Authors
Alberto Doretti
Irina Shestaritc
Daniela Ungaro
John-Ih Lee
Loukas Lymperopoulos
Lili Kokoti
Martina Guglielmetti
Dimos Dimitrios Mitsikostas
Christian Lampl
on behalf of the School of Advanced Studies of the European Headache Federation (EHF-SAS)
Publication date
01-12-2019
Publisher
Springer Milan
Published in
The Journal of Headache and Pain / Issue 1/2019
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI
https://doi.org/10.1186/s10194-019-1053-5

Other articles of this Issue 1/2019

The Journal of Headache and Pain 1/2019 Go to the issue

Research article

Primary headache disorders among the adult population of Mongolia: prevalences and associations from a population-based survey

Review article

New daily persistent headache: a systematic review on an enigmatic disorder

Review article

Emerging evidence of occipital nerve compression in unremitting head and neck pain

Research article

Efficacy of psychological treatment for headache disorder: a systematic review and meta-analysis

Research article

Influence of hemispheric white matter lesions and migraine characteristics on cortical thickness and volume

Review article

Animal models of migraine and experimental techniques used to examine trigeminal sensory processing