Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache (Executive Summary)

Godwin, Steven A.; Cherkas, David; Panagos, Peter; Shih, Richard D.; Byyny, Richard L.; Wolf, Stephen J.

doi:10.1016/s0196-0644(19)31168-0

Cited by 24 publications

(36 citation statements)

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“…Current evidence and guidelines suggest first line treatment of acute headache should include acetaminophen, NSAIDs, or anti‐dopaminergic agents while avoiding opioid usage . Our results suggest these guidelines are often not followed by EMS.…”

Section: Discussionmentioning

confidence: 89%

“…Although effective at treating an episode of acute headache, opioid treatment of headache has been associated with increased return ED visits, a longer ED length of stay, increased risk of developing chronic daily headaches, increased risk of opioid dependence, and more severe headache‐related disability . For these reasons, current guidelines for the treatment of headache in the emergency medicine setting recommend against using opioids as first‐line therapy . Introduction of an opioid‐free protocol for EMS may decrease utilization of opioids for headache.…”

Section: Discussionmentioning

confidence: 99%

“…The main goals in treating the atraumatic headache are ruling out life‐threatening conditions, treating pain, and preventing recurrence . The treatment for atraumatic headaches in the ED varies and includes dopaminergic antagonists, non‐steroidal anti‐inflammatory drugs (NSAIDS), typical antipsychotics, ketamine, and acetaminophen .…”

Section: Introductionmentioning

confidence: 99%

“…The treatment for atraumatic headaches in the ED varies and includes dopaminergic antagonists, non‐steroidal anti‐inflammatory drugs (NSAIDS), typical antipsychotics, ketamine, and acetaminophen . Despite professional association guidelines recommending against the routine use of opioids for atraumatic headache, opioids made up more than half of all medications given to treat this condition in one multicenter ED study in 2010 …”

Section: Introductionmentioning

confidence: 99%

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Out‐of‐hospital assessment and treatment of adults with atraumatic headache

Jarvis

Johnson

Crowe³

2020

JACEP Open

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Objective Little is known about the presentation or management of patients with headache in the out‐of‐hospital setting. Our primary objective is to describe the out‐of‐hospital assessment and treatment of adults with benign headache. We also describe meaningful pain reduction stratified by commonly administered medications. Methods This retrospective evaluation was conducted using data from a large national cohort. We included all 911 responses by paramedics for patients 18 and older with headache. We excluded patients with trauma, fever, suspected alcohol/drug use, or who received medications suggestive of an alternate condition. We presented our findings with descriptive statistics. Results Of the 5,977,612 emergency responses, 1.1% (66,235) had a provider‐documented primary impression of headache or migraine and 52.5% (34,763) met inclusion criteria. An initial pain score was recorded for 73.5% (25,544) of patients, and 58.5% (14,948) of these patients had multiple pain scores documented. Of the patients with multiple pain scores documented, 53.8% (8037) of patients had an initial pain score >5. Of these, 7.1% (573) were administered any medication. Among patients receiving a single medication, Fentanyl was the most commonly administered (32.1%, 126). As a group, opioids were the most commonly administered class of drugs (38.9%, 153) and were associated with the largest proportion of clinically significant pain reduction (69.3%, 106). Dopamine antagonists were given least frequently (9.9%, 39) but had the second largest proportion of pain reduction (43.6%, 17). Conclusion Out‐of‐hospital pain scores were documented infrequently and less than one in five patients with initial pain scores >5 received medication. Additionally, adherence to evidence‐based guidelines was infrequent.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Out‐of‐hospital assessment and treatment of adults with atraumatic headache

Jarvis

Johnson

Crowe³

2020

JACEP Open

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“…While migraine causes approximately 1/3 of these visits, life‐threatening disorders can also present with headache and it is essential to exclude these possibilities. The American College of Emergency Physicians (ACEP) recently published guidelines on the diagnosis and management of acute nontraumatic headaches in the ED . The following questions were proposed and addressed:…”

Section: Introductionmentioning

confidence: 99%

ACEP Guidelines on Acute Nontraumatic Headache Diagnosis and Management in the Emergency Department, Commentary on Behalf of the Refractory, Inpatient, Emergency Care Section of the American Headache Society

et al. 2020

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The American College of Emergency Physicians (ACEP) published guidelines in July 2019 on the diagnosis and management of acute nontraumatic headaches in the emergency department, focusing predominantly on the diagnosis of subarachnoid hemorrhage and the role of imaging and lumbar puncture in diagnosis. The ACEP Clinical Policies document is intended to aide Emergency Physicians in their approach to patients presenting with acute headache and to improve the accuracy of diagnosis, while promoting safe patient care practices. The Clinical Policies document also highlights the need for future research into best practices to distinguish primary from secondary headaches and the efficacy and safety of current treatment options for acute headaches. The following commentary on these guidelines is intended to support and expand on these guidelines from the Headache specialists’ perspective, written on behalf of the Refractory, Inpatient, Emergency Care section of the American Headache Society (AHS). The commentary have been reviewed and approved by Board of Directors of the AHS.

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Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge

et al. 2020

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Key Points Question How often do Medicare beneficiaries have an ambulatory follow-up visit after discharge from the emergency department, and is ambulatory follow-up associated with postdischarge outcomes? Findings In this cohort study of 9 470 626 emergency department discharges from 2011 to 2016, most patients had ambulatory follow-up within 30 days, with lower rates among Medicaid-eligible beneficiaries, Black beneficiaries, and those treated at rural emergency departments. Ambulatory follow-up was associated with a higher risk of subsequent hospitalization but a lower risk of 30-day mortality. Meaning The findings of this study suggest that access to ambulatory care may be a key driver of outcomes among Medicare beneficiaries discharged from the emergency department.

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Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache (Executive Summary)

Cited by 24 publications

References 0 publications

Out‐of‐hospital assessment and treatment of adults with atraumatic headache

Out‐of‐hospital assessment and treatment of adults with atraumatic headache

ACEP Guidelines on Acute Nontraumatic Headache Diagnosis and Management in the Emergency Department, Commentary on Behalf of the Refractory, Inpatient, Emergency Care Section of the American Headache Society

Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge

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