COVID-19 lockdown attack on headache emergency admissions: a multidisciplinary retrospective study

Abstract

Background During the first COVID-19 lockdown in Italy, it was observed a reduction in emergency department (ED) attendances due to non-SARS-COV-2-related acute/chronic conditions. Objective To analyze the impact of the COVID-19 lockdown on patients reporting headache as the principal presenting symptom on admission to the ED of the tertiary care University Hospital of Trieste over the relevant period. Methods We retrospectively evaluated the frequency, features, and management of ED attendances for headache during the COVID-19 lockdown from 8 March to 31 May 2020, comparing it with the pre-lockdown period (January-February 2020) and the first 5 months of 2019. Results A reduction in ED total attendances was observed in the first 5 months of 2020 compared to the same period in 2019 (21.574 and 30.364, respectively; − 29%), in particular with respect to headache-related attendances (174 and 339 respectively; − 49%). During the COVID-19 lockdown, it was recorded a minor reduction in the ED access rate of female patients (p = 0.03), while no significant variation was detected in repeaters' prevalence, diagnostic assessment, and acute treatment. The ratio of not otherwise specified, secondary, and primary headaches (48.4%, 30.6%, and 21.0% respectively) remained unchanged during the COVID-19 lockdown, in comparison to the control periods. ConclusionThe COVID-19 pandemic impacted the number of ED attendances for headache but not their management and setting. Despite a reduction of accesses for headache due to the pandemic emergency, the distribution of headache subtypes and the rate of repeaters did not change. KeywordsCOVID-19 • Headache • Emergency department • Lockdown • Repeaters Abbreviations ED Emergency department SARS-COV-2 Severe acute respiratory syndrome coronavirus 2 COVID-19 Coronavirus disease 19 NOS Not otherwise specified CT Computed tomography * Paolo Manganotti

Impact of the COVID-19 Pandemic on Inpatient Utilization for Acute Neurologic Disease

“…The literature regarding admission for other neurologic conditions is nascent; studies have largely been conducted in small US samples, 23,24 international cohorts, [25][26][27][28][29] or focused on survey-based methods. 30,31 Similar to our findings, these studies found decrements in admissions for neurotrauma, 23,24 neuro-oncologic surgical cases, 31 epilepsy, 25 headache, 26 neurodegenerative, 28 and neuro-inflammatory disorders 29 during the initial phase of the pandemic. Among the various categories of neurologic disease, we found headache hospitalizations to be most impacted, falling 66.7% in April and still being down by 20.5% by the October rebound period.…”

“…This reflects a similar trend seen in Italy, where emergency department visits for headache was reduced by 49% during the months of March to May 2020, compared with January to February of the same year. 26 These trends may reflect an ameliorative effect of the work-from-home accommodations imposed by the pandemic on primary 15 Quartiles cutoffs: first quartile (≤0), second quartile (1-6), third quartile (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), fourth quartile (>23). The Neurohospitalist 14 (1) headache disorders.…”

“…This reflects a similar trend seen in Italy, where emergency department visits for headache was reduced by 49% during the months of March to May 2020, compared with January to February of the same year. 26 These trends may reflect an ameliorative effect of the work-from-home accommodations imposed by the pandemic on primary headache disorders. 32 However, there may have also been greater reluctance to present for acute treatment for headache, a condition which patients may perceive as a lower priority compared to other health problems.…”

Impact of COVID-19 Pandemic on Headache Evaluations in the Pediatric Emergency Department

“…To our knowledge, the impact of Covid-19 pandemic on ED attendances specifically for headache has been investigated only in adult patients, in which a reduction of ED accesses without any change in the distribution of headache subtypes has been documented [ 7 ].…”

“…The secondary aim of the study was to define and compare the clinical features of headache in children evaluated in the ED during a period preceding the pandemic and during the Covid-19 pandemic. Based on published data on ED attendances for headache in adult patients [ 7 ] and general care in pediatric patients [ 8 , 9 ], we should expect a reduction of the evaluation rate in the pediatric ED fore headache during the pandemic period.…”