Risk stratification of non-traumatic headache in the emergency department

Grimaldi, Daniela; Nonino, Francesco; Cevoli, Sabina; Vandelli, Alberto; D'Amico, Roberto; Cortelli, Pietro

doi:10.1007/s00415-009-0033-0

Cited by 19 publications

(19 citation statements)

References 16 publications

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“…SAH is a common cause of acute secondary headache in emergency settings [1][2][3][4][5][6]. The present data demonstrated that SAH is also common cause of acute seconddary headache in hospitalized patients.…”

Section: Discussionsupporting

confidence: 51%

“…However, the underlying causes may change pattern over time particularly where there is rapid social development. Clinical study of acute headache presenting in emergency departments has been previously reported [1][2][3][4][5]. Many acute secondary headaches can be misdiagnosed if appropriate investigations are not made, even life-threatening subarachnoid hemorrhage (SAH) [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Acute headache in general neurology of China: Cause changes and predictors of short-term outcome

Wang¹,

Zhou²,

Chen³

et al. 2012

WJNS

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Background: Although patients with acute headache frequently present in emergency department, the causes and predictors of short-term outcome in patients with acute headache in general neurology have not been adequately investigated. Methods: We prospectively reviewed the medical records of 130 hospitalized acute headache pa-tients in general neurology of China. Their initial CT scan was assessed, as was their lumbar puncture (LP) examination if performed. Results: The main cause of acute headache was acute secondary headache (80.8%), which was mainly attributable to acute cerebrovascular events (72.4%) followed by intracranial infection (19.0%). Among the 10.8% of patients who died during hospitalization most (85.7%) had subarachnoid hemorrhage (SAH). Significant predictors of survival were severe headache versus thunderclap headache, meningismus, de-layed loss of consciousness, and hypertension (all p < 0.05). Multiple logistic regression analyses showed significant differences in severe headache or thunderclap headache (OR, 0.255; 95%CI, 0.066 - 0.990; p = 0.048) and delayed loss of consciousness (OR, 0.060; 95%CI, 0.016 - 0.224, p = 0.000) between patients who died and those who survived. Conclusions: The main underlying cause of hospitalized acute headache was acute cerebrovascular events. Severe headache and delayed loss of consciousness are predictors for poor outcome of acute headache

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Section: Discussionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Acute headache in general neurology of China: Cause changes and predictors of short-term outcome

Wang¹,

Zhou²,

Chen³

et al. 2012

WJNS

View full text Add to dashboard Cite

show abstract

“…In the ED, non-contrast computed tomography (CT) is the preferred imaging study and is used to rule out hemorrhage, while most patients should perform a magnetic resonance imaging (MRI) brain scan followed by CT/MRI angiography if brain vessel disease is suspected (such as, CAD, aneurysms, and CVST). Lumbar puncture with CSF analysis may help to diagnose SAH, infection, tumor and disorders related to CSF hypertension or hypotension[ 3 , 4 ]. Treatment and prognosis depend on the etiology of the headache.…”

mentioning

confidence: 99%

Secondary headache in emergency

Carolei

Ripa

2015

J Headache Pain

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“…However, in 3.8 – 20% of headache patients, a headache secondary to a potentially life-threatening condition is diagnosed with immediate implications for therapeutic interventions. These include subarachnoidal hemorrhage, cerebral aneurysm, intracranial bleeding, sinus vein thrombosis, temporal arteriitis, or meningitis [ 2 , 5 – 7 ]. It has been shown by various authors that red flags like age >50 years, focal-neurological signs, thunderclap onset of symptoms or altered mental status have a remarkable negative predictive value around 0.98–0.99, however with varying sensitivities (between 0.39 and 100%) and specificities (between 65 and 98%) [ 7 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…These include subarachnoidal hemorrhage, cerebral aneurysm, intracranial bleeding, sinus vein thrombosis, temporal arteriitis, or meningitis [ 2 , 5 – 7 ]. It has been shown by various authors that red flags like age >50 years, focal-neurological signs, thunderclap onset of symptoms or altered mental status have a remarkable negative predictive value around 0.98–0.99, however with varying sensitivities (between 0.39 and 100%) and specificities (between 65 and 98%) [ 7 – 11 ]. To improve the differentiation of benign headaches from secondary, potentially serious headache forms, various clinical algorithms which include these red flags have been proposed, but they are only inconsistently applied in clinical practice [ 7 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

et al. 2017

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BackgroundIn the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out.Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.MethodsPatients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.ResultsOf the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52–2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63–0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26–2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001).Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.ConclusionsCopeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.Trial registrationStudy Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov.Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-017-0733-2) contains supplementary material, which is available to authorized users.

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Risk stratification of non-traumatic headache in the emergency department

Cited by 19 publications

References 16 publications

Acute headache in general neurology of China: Cause changes and predictors of short-term outcome

Acute headache in general neurology of China: Cause changes and predictors of short-term outcome

Secondary headache in emergency

Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

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