Headaches in the emergency department –a survey of patients’ characteristics, facts and needs

Doretti, Alberto; Shestaritc, Irina; Ungaro, Daniela; Lee, John Ih; Lymperopoulos, Loukas; Kokoti, Lili; Guglielmetti, Martina; Mitsikostas, Dimos D.; Lampl, Christian

doi:10.1186/s10194-019-1053-5

Cited by 51 publications

(59 citation statements)

References 18 publications

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“…Patients with migraine accounted for 52.19% of all patients with an emergency headache. These data are consistent with other studies [23]. Emergency department physicians are often unable to determine the exact diagnosis of a patient's headache, and thus they are only able to provide a "pending headache" diagnosis.…”

Section: Discussionsupporting

confidence: 89%

Headache in the emergency department in Chongqing Province, China: A multicentre study

Tao

et al. 2020

Preprint

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Background: To investigate the present situation of emergency headache in many general hospitals in Chongqing Province, China.Methods: From January 1 to December 31, 2017, we studied patients who complained of headaches as the main symptom in the emergency department of 17 general hospitals in Chongqing Province. Each patient with a headache was interviewed and the medical history was collected by administering a questionnaire. The diagnosis of headache is based on the third edition of the International Classification of Headache Disorders (ICHD-3 beta). Results: In 2017, 16434 patients complained of headache in 17 general hospitals in Chongqing, accounting for 2.3% of all emergency patients. Eight thousand one male patients (48.7%) and 8433 female patients (51.3%) experienced a headache. The average age was (41.8 ± 13.2) years, and the course of disease was 3 hours to 15.2 years. Regarding the initial diagnosis, 7299 patients (44.4%) were diagnosed secondary headache, 5076 (30.9%) were diagnosed with primary headache and 4059 (24.865%) could not be diagnosed. The hospitalization rates for these patients were 60.3%, 12.2%, and 41.5%, respectively. Migraine is still the most common type of primary headache. Conclusions: This study shows that the misdiagnosis rate and missed diagnosis rate of patients with an emergency headache are high, and the emergency department still performs overtesting and hospitalizations.

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Section: Discussionsupporting

confidence: 89%

Headache in the emergency department in Chongqing Province, China: A multicentre study

Tao

et al. 2020

Preprint

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“…The majority of patients presenting to EDs with headache receive a diagnosis of primary benign headache and usually belong to younger age segments. 17,18 Similarly, the number of presentations due to visual disturbances, a broad term covering a wide range of manifestations from blurred vision to symptoms indicating potentially serious pathology such as amaurosis fugax or hemianopia, also decreased. In our ED, there is no clear-cut a priori distinction as to whether patients are referred to the ED neurologist or the hospital's ophthalmological emergency service.…”

Section: Discussionmentioning

confidence: 99%

<p>Changes in Demographic and Diagnostic Spectra of Patients with Neurological Symptoms Presenting to an Emergency Department During the COVID-19 Pandemic: A Retrospective Cohort Study</p>

Hoyer¹,

Graßl²,

Bail³

et al. 2020

NDT

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Objective: To analyse the characteristics of patients with neurological complaints seeking evaluation in an interdisciplinary emergency department (ED) during the rise of the COVID-19 pandemic in Germany. Methods: In this retrospective study, data on the number of ED presentations due to neurological complaints in weeks 1-15/2020 were collected. In addition, hospital chart data of patients referred for neurological evaluation during weeks 12-15/2020 when the pandemic began impacting on public life in Germany were analysed regarding demographic information, chief complaints, modes of presentation and disposition and ED discharge diagnosis. Both data sets were compared to respective periods from 2017. Results: During the surge of COVID-19, we found a significant decrease of the total number of neurological ED patients by 47.6%. Comparing weeks 12-15 of 2017 and 2020, we found a decrease in the number of patients of <30 years (p<0.001) and an increase of those � 70 years (p<0.001). A higher proportion of patients were admitted to escalated care (p=0.03), and fewer patients were discharged against medical advice (p<0.001). In addition, the ratio of less acute diagnoses (eg, benign headaches) declined significantly. Conclusion: Our findings suggest that the pandemic has contributed to a-potentially transient-reframing of laypeople's perception of urgency and necessity for emergency presentation. The establishment and promotion of health-care structures and services like telemedical consultations and the creation of safe ED environments will be essential to enable adequate delivery of care in potential future waves of the pandemic.

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“…In the ED, as in the general population, primary headache disorders are much more common than secondary disorders and it can be challenging for ED doctors to distinguish the few patients with potentially life-threatening headaches among the vast majority with benign headaches [6]. A primary headache is diagnosed in 58-81.2% of patients entering the ED with headache and, as regards the specific diagnosis of primary headache, migraine is the main condition, which represent 17-64% of cases [7][8][9][10]. While most headaches have benign etiology and are self-limiting, up to 5% have a serious and life-threatening cause (e.g., subarachnoid hemorrhage) that requires immediate medical attention [11,12].…”

Section: Introductionmentioning

confidence: 99%

Rapid referral for headache management from Emergency Department to Headache Centre: four years data

Negro

Spuntarelli

Sciattella

et al. 2020

Preprint

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Background Headache is one of the most common reason for medical consultation to emergency department (ED). Inappropriate use of ED for non-urgent conditions is a problem in terms of crowding emergency facilities, unnecessary testing and treatment, increased medical bills, burden on medical service providers and weaker patient-primary care provider relationships. The aim of this study was to analyzed the different steps of the ED management of patients with headache to detect those deficiencies that can be overcome by a prompt referral to a headache clinic.Methods The study is a retrospective analysis of the electronic medical records (EMRs) of patients discharged from an academic ED between 1 January 2015 and 31 December 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all the aspects related to the permanence in ED and we also assessed if there was a concordance between ED diagnosis and ours.Results Among our sample of 244 patients, 76.2% were admitted as green tag, 75% underwent a head computed tomography, 19.3% received neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. Length in ED stay was associated with the complaint of the first aura ever (p = 0.014) and if patients received consultations (p < 0.001). Concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.Conclusions The majority of patients who went to the ED complaining of headache received the same therapy regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the several shortcomings of ED management of headaches, a rapid referral to the headache centre is of primary importance to help the patient obtain a definite diagnosis and adequate treatment.

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Headaches in the emergency department –a survey of patients’ characteristics, facts and needs

Cited by 51 publications

References 18 publications

Headache in the emergency department in Chongqing Province, China: A multicentre study

Headache in the emergency department in Chongqing Province, China: A multicentre study

<p>Changes in Demographic and Diagnostic Spectra of Patients with Neurological Symptoms Presenting to an Emergency Department During the COVID-19 Pandemic: A Retrospective Cohort Study</p>

Rapid referral for headache management from Emergency Department to Headache Centre: four years data

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