Rapid referral for headache management from emergency department to headache centre: four years data

Abstract

Background Headache is one of the most common reason for medical consultation to emergency department (ED). The inappropriate use of ED for non-emergency conditions is a problem in terms of overcrowding of emergency facilities, unnecessary testing and treatment, increased medical costs, burden on medical service providers and weaker relationships between patient and primary care provider. The aim of this study was to analyze the different stages of ED management of headache to identify those deficiencies that can be overcome by a fast referral to a headache clinic. Methods The study is a retrospective analysis of the electronic medical records of patients discharged from an academic ED between January 1, 2015 and December 31, 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all aspects related to the permanence in ED and also assessed whether there was a match between the diagnosis made in ED 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 a neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. The length of stay in ED was associated with reporting the first aura ever (p = 0.014) and whether patients received consultations (p < 0.001). The concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre. Conclusions Most patients who went to ED complaining of headache received the same treatment regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the many shortcomings in headache management in ED, rapid referral to the headache centre is of paramount importance to help the patient achieve a definiteve diagnosis and appropriate treatment.

The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

“…The extent to which CT scans are performed in headache patients at emergency rooms worldwide varies widely (27-75%) (11)(12)(13)(14). Overall, previous research showed a similar low-threshold tendency to perform neuroimaging in the ED setting in both adults and children, with low diagnostic yield (12,(15)(16)(17)(18). Our finding of intracranial pathology in 13% of cranial CT scans is in accordance with results presented in previous studies (19)(20)(21).…”

“…As shown previously, abnormal CT results are rare in headache patients without neurological deficits (10). The extent to which CT scans are performed in headache patients at emergency rooms worldwide varies widely (27-75%) (11)(12)(13)(14). Overall, previous research showed a similar low-threshold tendency to perform neuroimaging in the ED setting in both adults and children, with low diagnostic yield (12,(15)(16)(17)(18).…”

Impact of emergency department opioid use on future health resource utilization among patients with migraine

“…1 rapid referral to a headache clinic or specialist after ruling out severe or life-threatening secondary headache by ED physicians could help patients receive a more accurate diagnosis and appropriate treatment while reducing ED resource utilization at the same time. 18,19 Our study found that more than one-third and opioids (17.6%), whereas triptans were not received by any of those patients (n = 244). 18 Another study, which was conducted in China, reported that 7.1% of patients with migraine received opioids as acute mediations despite of the fact that opioids are subject to government regulation in China.…”

“…18,19 Our study found that more than one-third and opioids (17.6%), whereas triptans were not received by any of those patients (n = 244). 18 Another study, which was conducted in China, reported that 7.1% of patients with migraine received opioids as acute mediations despite of the fact that opioids are subject to government regulation in China. 21 It is important to note that the migraine treatment guidelines from US, Europe, and China all clearly discourage the use of opioids for acute treatment due to limited efficacy and concern of overuse.…”

Practical use of non-steroidal anti-inflammatory drugs in relieving recurrent headaches

“…Универсальность этого класса лекарственных средств в лечении ГБ связана с большим опытом их применения, изученностью и наличием рандомизированных контролируемых исследований (РКИ) при всех первичных цефалгиях. Например, среди пациентов с жалобами на ГБ в итальянской университетской больнице (за период наблюдения 4 года) чаще всего врачи назначали НПВП -в 44,3% случаев, реже -опиоиды (17,6%), тогда как парацетамол -только в 8,2% случаев [35]. В исследовании, проведенном во Франции, НПВП назначались наиболее часто (в 42,9% случаев), реже врачи выписывали опиоидные анальгетики (9,1%), противорвотные (8%) и противотревожные препараты (3%) [36].…”