Headache in the Emergency Department

Friedman, Benjamin W.; Lipton, Richard B.

doi:10.1007/s11916-011-0189-z

Cited by 13 publications

(7 citation statements)

References 22 publications

(12 reference statements)

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“…The effective triaging of patients presenting with primary versus secondary headache is an important and currently unmet need [ 1 , 5 , 14 ]. Consideration of patients’ medical history and physical examination are currently the most important aspects of headache assessment, and clinicians must be vigilant for “red flag” symptoms that are characteristic of serious secondary causes [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Consideration of patients’ medical history and physical examination are currently the most important aspects of headache assessment, and clinicians must be vigilant for “red flag” symptoms that are characteristic of serious secondary causes [ 1 , 3 ]. This qualitative approach could be complimented by a quantitative methodologic tool, which could potentially streamline diagnosis, facilitate clinical decision-making, and reduce unnecessary investigations [ 2 , 5 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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A machine learning approach to support triaging of primary versus secondary headache patients using complete blood count

Yang

Tao²,

Torben‐Nielsen³

et al. 2023

PLoS ONE

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Headaches account for up to 4.5% of emergency department visits, where they present a significant diagnostic challenge. While primary headaches are benign, secondary headaches can be life-threatening. It is essential to rapidly differentiate between primary and secondary headaches as the latter require immediate diagnostic work-up. Current assessment relies on subjective measures; time constraints can result in overuse of diagnostic neuroimaging, prolonging diagnosis, and adding to economic burden. There is therefore an unmet need for a time- and cost-efficient, quantitative triaging tool to guide further diagnostic testing. Routine blood tests may provide important diagnostic and prognostic biomarkers indicating underlying headache causes. In this retrospective study (approved by the UK Medicines and Healthcare products Regulatory Agency Independent Scientific Advisory Committee for Clinical Practice Research Datalink (CPRD) research [20_000173]), UK CPRD real-world data from patients (n = 121,241) presenting with headache from 1993–2021 were used to generate a predictive model based on a machine learning (ML) approach for primary versus secondary headaches. A ML-based predictive model was constructed using two different methods (logistic regression and random forest) and the following predictors were evaluated: ten standard measurements of complete blood count (CBC) test, 19 ratios of the ten CBC test parameters, and patient demographic and clinical characteristics. The model’s predictive performance was assessed using a set of cross-validated model performance metrics. The final predictive model showed modest predictive accuracy using the random forest method (balanced accuracy: 0.7405). The sensitivity, specificity, false negative rate (incorrect prediction of secondary headache as primary headache), and false positive rate (incorrect prediction of primary headache as secondary headache) were 58%, 90%, 10%, and 42%, respectively. The ML-based prediction model developed could provide a useful time- and cost-effective quantitative clinical tool to facilitate the triaging of patients presenting to the clinic with headache.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A machine learning approach to support triaging of primary versus secondary headache patients using complete blood count

Yang

Tao²,

Torben‐Nielsen³

et al. 2023

PLoS ONE

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“…2,4–7 Differentiating secondary headaches from primary headaches is an essential skill in order to prevent any morbidities and mortalities. 1,8,9 Developing reproducible management strategies for headache in ED provides effective outcome. 8…”

Section: Introductionmentioning

confidence: 99%

Clinical availability of SNOOP4 in acute non‐traumatic headache patients admitted to the emergency department

Wongtanasarasin

Wittayachamnankul

2022

Hong Kong j. emerg. med.

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Objectives: Non-traumatic headache accounts for up to 4.5% of all patients presenting to the emergency department. Non-traumatic headache is generally classified into two categories: primary and secondary headache disorders. Differentiating secondary from primary headache disorders is essential. SNOOP4 is known as a mnemonic for suggesting clinicians send neuroimaging to rule out serious conditions. Yet, the benefit of using this mnemonic in the emergency department is not well established. This study aimed to assess the significance of SNOOP4 in detecting serious causes of non-traumatic headache in adults presenting to the emergency department. Methods: We conducted a prospective observational study of adult patients presenting to the emergency department of the single tertiary hospital over a period of 12 months. Patients with acute non-traumatic headache presented at the emergency department were included. A standard record form was used. Patients were investigated and treated following the pre-existing protocols. Results were interpreted by attending radiologists. Each factor, according to SNOOP4, was then evaluated for the ability to predict serious causes of non-traumatic headache. Results: A total of 90 patients were included in this study with complete details obtained on 83 (92.2%) patients. Of these, 63 (75.9%) were female. The mean age was 44.5 years (inter-quartile range: 27–58.5). The duration of the headache ranged from 10 min to 7 days. Out of 83, 27 (32.5%) had at least one SNOOP4 criterion. In all, 25 patients (30.1%) underwent neuroimaging. The sensitivity, specificity, positive predictive value, and negative predictive value of SNOOP4 were 77.8%, 73.0%, 25.9%, and 96.4% respectively. Conclusion: SNOOP4 criteria show very high negative predictive value for excluding serious causes of acute non-traumatic headache in adult patients presenting to the emergency department.

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“…primary) care whenever possible (Thakkur et al, 2015). In the ER setting, the main priority of clinicians is the detection of potential life-threatening causes of headache (Davenport 2002;Friedman et al, 2011).…”

Section: Abbreviation Listmentioning

confidence: 99%

“…They are used in other fields of neurology and medicine, and are part of daily practice(Ramanayake et al, 2018). The evidence supporting their use is mostly based on expert opinion, which is valuable but not fully precise(Edmeads, 1990;Evans et al, 2011;Friedman et al, 2011. Most authors agree on the fact that the presence of any single red flag requires that a secondary headache disorder be ruled out.…”

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confidence: 99%

Red Flags in the evaluation of patients with headache in the emergency department: the good, the bad and the ugly

García‐Azorín¹

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BackgroundHeadache is a frequent complaint in the emergency room. The detection of patients with a secondary life-threatening cause of headache is the main priority. Due to the absence of specific biomarkers, diagnosis of secondary headache disorders is still based on the presence of red flags. In headache medicine, red flags are pieces of information whose presence increases the likelihood of having a secondary headache disorder. There are four major subgroups of red flags, elements related to: the prior history of the patient, an atypical headache phenotype, the presence of unusual symptoms or an abnormal neurological examination. ObjectiveWe aimed to evaluate the frequencies and types of red flags in patients who presented to the emergency room and had a confirmed diagnosis of one of the following secondary headache disorders: cerebral venous sinus thrombosis (CVST) or coronavirus disease 2019 . We also analyzed patients who were discharged from the emergency room with a definite diagnosis of tension-type headache (TTH). MethodsWe conducted three observational descriptive studies with cross-sectional design. The studies took place in two third-level academic hospitals and were approved by the Ethics Review Boards of both hospitals. The study population included patients with headache that visited the emergency room. Patients were excluded if another headache disorder was present or if there was some degree of uncertainty in the diagnosis. All potential cases were systematically screened for eligibility during each study period. In each case, two neurologists with expertise on headache medicine assessed for the presence of red flags in each patient who fulfilled the eligibility criteria. A pre-defined questionnaire that included the main red flags was used, based on the International Headache Society and Spanish Society of Neurology proposals.

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Headache in the Emergency Department

Cited by 13 publications

References 22 publications

A machine learning approach to support triaging of primary versus secondary headache patients using complete blood count

A machine learning approach to support triaging of primary versus secondary headache patients using complete blood count

Clinical availability of SNOOP4 in acute non‐traumatic headache patients admitted to the emergency department

Red Flags in the evaluation of patients with headache in the emergency department: the good, the bad and the ugly

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