Headache Characteristics in the Neurological Emergency Department: A Retrospective Study

Abstract

Background: The care of patients with headache in the emergency department (ED) represents a diagnostic and clinical challenge. Data on the prevalence and characteristics of headache patients in purely neurological EDs are sparse. The aim of the present study is to examine patient profiles with the cardinal symptom of headache in an academic neurological ED, to analyze correlations between headache characteristics and search for differences compared to the interdisciplinary ED.Methods: This retrospective cross-sectional study assessed all patients who presented to the ED of the Department of Neurology at Rostock University Medical Center between November 2013 and November 2016 with the main symptom of headache. Epidemiological, clinical, diagnostic data as well as key data regarding the care structure were recorded. Correlations between headache characteristics and diagnosis at discharge were analyzed and risk profiles were identified using binary logistic regression analysis.Conclusion: This study comprehensively characterized a large collective of patients with the cardinal symptom of headache presenting to a purely neurology emergency department.

Headache in the Neurological Emergency Department—High Degree of Inadequate Documentation Calls for Structured Assessments

“…The structured headache interview suggested by us is short, concise, and feasible for use in acute medical settings with time constraints ( Table 3 ). It includes warning symptoms for secondary headache (“red flags”) as described in the literature ( 13 , 19 ) and additionally, “cardiovascular diseases in history,” for which we found a high correlation with secondary headache ( 5 ). Furthermore, it addresses characteristics and symptoms important for the diagnosis of a primary headache according to the ICHD-3 classification ( 8 ).…”

“…We conducted a retrospective analysis based on the data recorded in the previously published study from our group on patients who presented to the neurological ED at Rostock University Medical Center with the main symptom of headache between November 2013 and November 2016 ( 5 ). In detail, it was recorded whether warning symptoms (“red flags”) for a secondary headache, as well as core clinical characteristics essential for correct headache diagnosis using the ICHD-3 classification were documented in the medical charts.…”

“…While primary headaches such as migraine are predominant ( 3 ), there is an inherent risk that secondary headaches with potential life-threatening implications illness remain undetected in the ED ( 4 ). In a retrospective cross-sectional study carried out by our group in patients with the cardinal symptom of headache in a neurological emergency department, we had previously found a headache prevalence of 9.1% ( 5 ). Of these, primary headaches amounted to 40.1%, while secondary headaches were found in 29%.…”

“…Primary headache is frequently under- or misdiagnosed in the ED, resulting in inadequate treatment ( 10 – 12 ). Indeed, we found that 24.7% of patients with headache in the neurological ED did not receive a specific diagnosis beyond headache as such ( 5 ). Therefore, the present study aimed to enquire how often warning symptoms (“red flags”) were documented and which essential clinical characteristics allowing diagnosis according to the ICHD-3 criteria were recorded.…”

Kopfschmerz in der Notaufnahme – „Red Flags“ zuverlässig erkennen

“…So berichten bis zu 4% der in Notaufnahmen vorstelligen Patienten über Kopfschmerzen [1, 2, 3]. Innerhalb des Patientenkollektivs, welches sich mit neurologischen Symptomen vorstellte, ergab eine repräsentative Untersuchung einer deutschen Universitätsklinik einen Anteil von 9,1% mit dem Leitsymptom Kopfschmerz [4]. Die Erwartungen der Betroffenen variieren dabei stark und reichen vom Abklärungswunsch der zumeist akut aufgetretenen Symptomatik über die Schmerztherapie bei bereits länger bestehenden und mitunter therapierefraktären Beschwerden.…”