A primary headache adventure from the emergency department to the neurology outpatient clinic | [Rawal Medical Journal • 2024]

Author(s):

1. Sinan Eliaçık: Department of Neurology, Hitit University, Faculty of Medicine,Çorum,Turkey

Abstract:

Objective: To analyze the primary headache type, medical treatments initiated, and imaging characteristics of patients referred to neurology outpatient clinics from the emergency department. Methodology: Patients referred to neurology outpatient clinics from the emergency department between January 2014 and January 2024 were included in the study. Demographic data and case information were obtained from the hospital database. Results: The study included 6940 primary headache patients. Of the patients included in the study, 4164 (60%) were female and 2776 (40%) male. The mean age was 36.02±15.21 years. The most common headache in female patients was migraine, and in male patients, it was a tension-type headache. The proportions of patients who underwent one, two, three, or more cranial imaging procedures in the emergency department within 10 years were 20%, 35%, and 45%, respectively. Eletriptan was the most used drug in the treatment of migraine attacks in 37.8%, Amitriptyline was used in 32.8% of patients for migraine prophylaxis and duloxetine was used in 31.1% of patients for tension type headaches. Conclusion: The management of primary headaches remains a challenge for primary care physicians. In a patient with severe pain, both medical history and neurologic examination are time-consuming. Considering the patient density and fast pace of work in the emergency department, misdiagnosis and analgesic treatments administered at every emergency department visit without considering the patient's past information delays the prophylactic treatment process in primary headaches and make treatment difficult.

Page(s): 1-4

DOI: DOI not available

Published: Journal: Rawal Medical Journal, Volume: 49, Issue: 4, Year: 2024

Keywords:

Migraine , headache , Cluster Headache , Emergency department , tension headache

References:

[1] Valade D,Ducros A .2010 .Acute headache in the emergency department. Hand Clin Neurol, 97 : 173-81.

[2] Edlow JA,Caplan LR .2000 .Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med, 342 : 29-36.

[3] Miyagami T,Watari T,Harada T,Naito T. Medical,Malpractice T. Medical .2023 .Diagnostic Errors in Japanese Emergency Departments. West J Emerg Med, 24 : 340-47.

[4] Edlow JA,Panagos PD,Godwin SA,Thomas TL,Decker WW. .2009 .Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. J Emerg Nurs, 35 : e43-71.

[5] Kowalski RG,Claassen J,Kreiter KT,Bates JE,Ostapkovich ND,Connolly ES .2004 .Initial misdiagnosis and outcome after subarachnoid hemorrhage. JAMA, 291 : 866-9.

[6] García-Azorín D,Farid-Zahran M,Gutiérrez-Sánchez M,González-García MN,Guerrero AL,Porta-Etessam J .2020 .Tension-type headache in the Emergency Department Diagnosis and misdiagnosis: The TEDDi study. Sci Rep, 10 : 2446-9.

[7] Arslan Ş .2020 .Acil servise başvuran migren hastalarının özürlülük, anksiyete ve depresyon oranlarının belirlenmesi. Turk Clin Lab, 11 : 1-6.

[8] Steiner TJ,Jensen R,Katsarava Z,Stovner LJ,Uluduz D,Adarmouch L .2021 .Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description. J Headache Pain, 22 : 1-22.

[9] Starling AJ .2018 .Diagnosis and management of headaches in older adults. Mayo Clin Proc, 93 : 252-62.

[10] Munoz-Ceron J,Marin-Careaga V,Peña L,Mutis J,Ortiz G .2019 .Headache at the emergency room: Etiologies, diagnostic usefulness of the ICHD 3 criteria, red and green flags. PLoS One, 14 : e0208728.

[11] Filler L,Akhter M,Nimlos P.,Evaluation P. .2019 .and management of the emergency department headache. Semin Neurol, 39 : 20-26.

[12] Rimmele F,Janke J,Kropp P .2021 .Headache characteristics in the neurological emergency department: a retrospective study. Front Neurol, 12 : 706074.

[13] Hsu TY,Ye JJ,Ye SY,Tseng HY,Chou WY,Kung PT .2023 .Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study. BMC Public Health, 23 : 283.

[14] Ardila CM,Gonzalez-Arroyave D,Angel S .2023 .Primary headache approach in the emergency departments: a systematic scoping review of prospective studies. Cureus, 15(3) : e36131.

[15] Viganò A,Savastano E,Petolicchio B,Toscano M,De Sanctis R,Maestrini I .2020 .A study of clinical features and risk factors of self-referring emergency department headache patients: a comparison with headache center outpatients. Eur Neurol, 83 : 34-40.

[16] .2023 .Cephalalgia-The early history. Cephalalgia, 43 : 1-7.

[17] Steiner TJ,Tinelli M. .2021 .Valuing headache's solution. J Headache Pain, 22 : 54.

[18] Chu K,Kelly AM,Kinnear F,Keijzers G,Kamona S. .2022 .Primary headache drug treatment in emergency departments in Australia and New Zealand. Med J Aust, 217 : 366.

[19] Fesmire FM,Bernstein D,Brecher D,Brown MD,Burton JH,Diercks DB .2014 .Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med, 63 : 437-47.

[20] Kuan WS,Kumar R,Yau YW,Ng WM,Chia DW,Ng EY .2023 .Headache in the Emergency Department: A Multicenter Observational Study from Singapore. Medicina, 59 : 1340-5.

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