Clinical features, diagnosis and treatment of acute primary headaches at an emergency center: why are we still neglecting the evidence?

Abstract

-In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.KEY WORDS: headaches, diagnostic approach, treatment. Características clínicas, diagnóstico e tratamento das cefaléias primárias agudas em um serviço de emergência. Por que ainda negligenciamos as evidências?RESUMO -Com o objetivo de avaliar as características clínicas, abordagem e tratamento das cefaléias agudas primárias atendidas no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU) no ano de 2005, 109 prontuários foram analisados através de questionário padronizado, segundo idade, sexo, diagnós-tico principal, características das crises, propedêutica e tratamento. A distribuição dos pacientes quanto ao tipo de cefaléia foi a seguinte: provável enxaqueca 47,7%, provável cefaléia tensional 37,6%, cefaléia não classificada 11,9% e cefaléia não classificada em outro local 2,8%. No que tange às características da crise, a localização da dor foi descrita em 86,2% dos pacientes. No tratamento dos pacientes com crise aguda de cefaléia, as drogas mais utilizadas foram: dipirona (74,5%), seguido de tenoxicam (31,8%), diazepam (20,9%), dramin ® (10,9%) e metoclopramida (9,9%). Os dados levantados são condizentes com os relatados na literatura. O tratamento efetuado, na maioria dos casos, não foi o recomendado por consensos ou estudos clíni-cos com metodologia aceitável. Recomendamos, portanto, a introdução de um protocolo específico para o atendimento das cefaléias agudas, o que facilitará o diagnóstico, tratamento e manejo destes pacientes.

Headache patients in the emergency department of a Greek tertiary care hospital

“…This goes in line with other studies reporting a female–male sex ratio between 2:1 [6, 8, 13] and 3:1 [9, 14, 15]. Even though the overall VAS pain score was high (almost 50% of patients rated their headache with a score higher or equal to 7), female patients rated their headache intensity with a higher score than male.…”

“…The high percentage (27.7%) of patients suffering from headache NOS in our study may be considered high, as in other reports, the incidence of primary headaches in the EDs reaches 64 [19], 80 [11] and 81.2% [20] and headache NOS was diagnosed in 14.9 [14] or 26% [6] of all headache patients only. However, other studies report a higher incidence of headache NOS, ranges from 42% [15, 16] to 59% [17].…”

“…In all other reports, the most frequent ED diagnosis for primary headache was migraine [6, 14–18]. In a nationwide study covering the period between 1992 and 2001 on headache management in US EDs, Goldstein et al [8] reported that the diagnosis of migraine was made in 63.5% of patients who attended the ED suffering from headache.…”

“…This percentage is four times higher than in our sample. But it has to be taken into account that in other studies, especially in the USA, the majority of the ED headache patients were seen by the ED physician and not by a board certified neurologist [6–9, 11, 13, 14, 17–19]. This difference in the management of headache patients does also lead to differences in treatment practice: In our hospital’s ED, opioids are rarely used for acute headache treatment, in contrast with US studies [13, 19].…”

Prevalence and management of headache in a selected area of Southern Santa Catarina

“…The use of medications, mainly common over-the-counter painkillers, was observed especially in acute crisis. The most frequently used drug was paracetamol, followed by dipyrone sodium, mentioned in various studies as the most common option for headache management 12,28 .…”