Clinic and Emergency Room Evaluation and Testing of Headache

Nye, Barbara; Ward, Thomas N.

doi:10.1111/head.12648

Cited by 25 publications

(21 citation statements)

References 29 publications

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“…4 In the PED, dangerous and reversible causes of headache must be eliminated by the attending physician. 4 In the PED, dangerous and reversible causes of headache must be eliminated by the attending physician.…”

Section: Discussionmentioning

confidence: 99%

“…The evaluation of patients presenting with a headache in the clinic and in the emergency department setting are very different. 4 In the PED, dangerous and reversible causes of headache must be eliminated by the attending physician. Evaluation should always start with the history, trying to determine if the headache etiology is primary (ie, migraine, cluster or other reasons that not due to an underlying cause) or secondary 1,13 (ie, due to an underlying cause such a mass lesion, infection, or other cause).…”

Section: Discussionmentioning

confidence: 99%

“…1 The role of the emergency physician is to distinguish between life-threatening etiologies that require immediate intervention and the primary headache. 4 The next priority is pain management, followed by a decision by the emergency physician whether the patient requires further evaluation or can be discharged home. Brain magnetic resonance imaging (MRI) is preferred over computed tomography (CT), 2 except in an emergency setting when hemorrhage, acute stroke, or head trauma are suspected.…”

Section: Introductionmentioning

confidence: 99%

“…3 When a child presents to the PED with an acute headache the attending physician will first focus on ruling out emergencies and identifying red flags suggestive of an intracranial tumor, especially if the child presents without fever or signs of meningitis. 4 The next priority is pain management, followed by a decision by the emergency physician whether the patient requires further evaluation or can be discharged home. 5 If there are any signs of emergency, CT scanners are often easy to access and provide information very quickly; in the outpatient settings, however, access to MRI is more readily available.…”

Section: Introductionmentioning

confidence: 99%

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Outpatient Management of Headache after Pediatric Emergency Department Visit: Are we Missing Anything?

et al. 2019

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Background Headache is a common complaint in children at a pediatric emergency department (PED). The primary objective of this analysis is to describe the outcome of patients presenting with headache to the PED and discharged with neurology follow up. The secondary objective is to describe the diagnostic evaluation children with headache underwent in the PED and to evaluate headache characteristics which are more likely associated with serious, life‐threatening conditions. Methods A retrospective chart review of children who were discharged from the PED after evaluation for headache, with a scheduled urgent neurology outpatient clinic follow up at the same institution, over a 3.5‐year period. Results During the study period, we identified 300 children whose admitting diagnosis was headache and they were discharged from the PED with a scheduled follow up. None of these patients had papilledema on fundoscopy performed by an ophthalmologist during the PED visit. Following neurology outpatient clinic visit, 62 (21%) were referred to perform brain magnetic resonance imaging. None of the patients had a diagnosis of brain tumor or any anatomic abnormality that could increase intracranial pressure. Conclusions No immediate life‐threatening cases presented to the follow up neurology clinic for evaluation. A scheduled urgent neurology outpatient clinic follow up in any child with headache who is discharged from the PED, offers a safety net, even when the physical examination including fundoscopy is normal.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outpatient Management of Headache after Pediatric Emergency Department Visit: Are we Missing Anything?

et al. 2019

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“…Patients with known cancer should have head imaging when a headache develops or if there is a change in headache characteristics [69].…”

Section: Variant 2: New Headache With Optic Disc Edema Initial Imagingmentioning

confidence: 99%

ACR Appropriateness Criteria® Headache

Whitehead

Cardenas

Corey

et al. 2019

Journal of the American College of Radiology

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Headache is one of the most common human afflictions. In most cases, headaches are benign and idiopathic, and resolve spontaneously or with minor therapeutic measures. Imaging is not required for many types of headaches. However, patients presenting with headaches in the setting of "red flags" such as head trauma, cancer, immunocompromised state, pregnancy, patients 50 years or older, related to activity or position, or with a corresponding neurological deficit, may benefit from CT, MRI, or noninvasive vascular imaging to identify a treatable cause. This publication addresses the initial imaging strategies for headaches associated with the following features: severe and sudden onset, optic disc edema, "red flags," migraine or tension-type, trigeminal autonomic origin, and chronic headaches with and without new or progressive features.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Treatment

Martelletti

2022

Migraine in Medicine

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Clinic and Emergency Room Evaluation and Testing of Headache

Abstract: At the end of the review we hope to have provided you with a framework to think about the headache patient and what is the appropriate test in the given clinical setting in order to ensure that the patient gets the right diagnosis and is set on a path to the appropriate management plan.

Cited by 25 publications

References 29 publications

Outpatient Management of Headache after Pediatric Emergency Department Visit: Are we Missing Anything?

Outpatient Management of Headache after Pediatric Emergency Department Visit: Are we Missing Anything?

ACR Appropriateness Criteria® Headache

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