scholarly journals Headache in the Emergency Department in Chongqing Province, China: A Multicentre Study

2020 ◽  
Author(s):  
Qin Li ◽  
Tao Ye ◽  
Jingxi Ma ◽  
Dongli Yuan ◽  
Xuemei Peng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Headache ◽  
Secondary Headache ◽  
General Hospitals ◽  
Course Of Disease ◽  
Hospitalization Rates ◽  
Diagnosis Rate ◽  
Missed Diagnosis ◽  
Male Patients

Abstract 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.

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

2020 ◽  
Author(s):  
Qin Li ◽  
Tao Ye ◽  
Jingxi Ma ◽  
Dongli Yuan ◽  
Xuemei Peng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Headache ◽  
Secondary Headache ◽  
General Hospitals ◽  
Course Of Disease ◽  
Hospitalization Rates ◽  
Diagnosis Rate ◽  
Missed Diagnosis ◽  
Male Patients

Abstract 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.

scholarly journals Headache in Patients With Pituitary Lesions: A Longitudinal Cohort Study

Neurosurgery ◽  
2015 ◽  
Vol 78 (3) ◽  
pp. 316-323 ◽  
Author(s):  
Paul Rizzoli ◽  
Sherry Iuliano ◽  
Emma Weizenbaum ◽  
Edward Laws
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Pituitary Surgery ◽  
Secondary Headache ◽  
Exact Nature ◽  
Questionnaire Response ◽  
Headache Diagnosis ◽  
Transsphenoidal Pituitary Surgery ◽  
The Relationship

Abstract BACKGROUND: Headache is a presenting feature in 37% to 70% of patients with pituitary tumor. Other pituitary lesions may also present with headache, and together these lesions account for about 20% of all primary brain lesions. Although pituitary lesions have been associated with headache, the exact nature of the relationship remains undefined. It is not always clear whether the presenting headache is an unrelated primary headache, a lesion-induced aggravation of a preexisting primary headache, or a separate secondary headache related to the lesion. OBJECTIVE: To characterize headache in patients referred to a multidisciplinary neuroendocrine clinic with suspected pituitary lesions and to assess changes in headache in those who underwent surgery. METHODS: We used a self-administered survey of headache characteristics completed by patients upon presentation and after any pituitary surgical procedure. RESULTS: One hundred thirty-three participants completed the preoperative questionnaire (response rate of 99%). The overall prevalence of headache was 63%. Compared to patients without headache, the group with headache was more likely to be female (P = .001), younger (P = .001), and to have had a prior headache diagnosis (P < .001). Seventy-two percent of patients reported headache localized to the anterior region of the head. Fifty-one patients with headache underwent transsphenoidal pituitary surgery. Headache was not associated with increased odds of having surgery (odds ratio, 0.90). At 3 months, 81% of surgically treated patients with headache who completed the postoperative questionnaire (21/26) reported improvement or resolution of headaches. No patient who completed the postoperative questionnaire (44/84) reported new or worsened headache. CONCLUSION: Frequent, disabling headaches are common in patients with pituitary lesions referred for neuroendocrine consultation, especially in younger females with a preexisting headache disorder. Surgery in this group was associated with headache improvement or resolution in the majority and was not found to cause or worsen headaches. Suggestions for revision of the International Classification of Headache Disorders diagnostic criteria pertaining to pituitary disorders are supported by these findings.

Characteristics of Brain Tumour-Associated Headache

Cephalalgia ◽  
2007 ◽  
Vol 27 (8) ◽  
pp. 904-911 ◽  
Author(s):  
CJ Schankin ◽  
U Ferrari ◽  
VM Reinisch ◽  
T Birnbaum ◽  
R Goldbrunner ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Univariate Analysis ◽  
Positive Family History ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Moderate Intensity ◽  
Secondary Headache ◽  
History Of ◽  
Type Headache

Eighty-five brain tumour patients were examined for further characteristics of brain tumour-associated headache. The overall prevalence of headache in this population was 60%, but headache was the sole symptom in only 2%. Pain was generally dull, of moderate intensity, and not specifically localized. Nearly 40% met the criteria of tension-type headache. An alteration of the pain with the occurrence of the tumour was experienced by 82.5%, implying that the preexisting and the brain tumour headaches were different. The classic characteristics mentioned in the International Classification of Headache Disorders (worsening in the morning or during coughing) were not found; this might be explained by the patients not having elevated intracranial pressure. Univariate analysis revealed that a positive family history of headache and the presence of meningiomas are risk factors for tumour-associated headache, and the use of β-blockers is prophylactic. Pre-existing headache was the only risk factor according to logistic regression, suggesting that patients with pre-existing (primary) headache have a greater predisposition to develop secondary headache. Dull headache occurs significantly more often in patients with glioblastoma multiforme, and pulsating headache in patients with meningioma. In our study, only infratentorial tumours were associated with headache location, and predominantly with occipital but rarely frontal pain.

Abstract P168: Impact of Oral Anticoagulation Choice on Healthcare Utilization for the Primary Treatment of Venous Thromboembolism

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Rob F Walker ◽  
Richard F Maclehose ◽  
J'Neka Claxton ◽  
Terrence Adam ◽  
Alvaro Alonso ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Oral Anticoagulation ◽  
Primary Treatment ◽  
Emergency Department Visits ◽  
Office Visits ◽  
International Classification Of Disease ◽  
Hospitalization Rates ◽  
The Impact

Introduction: Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during the primary treatment of VTE. Hypothesis: Among anticoagulant-naïve VTE patients we tested the hypotheses that the number of hospitalizations, days hospitalized, emergency department visits, and outpatient office visits would be lower among users of rivaroxaban or apixaban than among users of warfarin. Methods: MarketScan databases for years 2016 and 2017 were used to identify VTE cases and comorbidities using international classification of disease codes, and prescriptions for OACs via outpatient pharmaceutical claims data. Healthcare utilization was identified in the first 6 months after initial VTE diagnoses. Results: The 23,864 individuals with VTE cases were on average (± standard deviation) 55.7 ± 16.1 years old and 50.6% female. Participants had on average 0.2 ± 0.5 hospitalizations, spent 1.3 ± 5.2 days in the hospital, had 5.7 ± 5.1 outpatient encounters, and visited an emergency department 0.4 ± 1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, office visits and emergency department visits, after accounting for age, sex, comorbidities and medications (Table 1). For example, hospitalization rates were 24% lower [IRR: 0.76 (95% CI: 0.69, 0.83)] for patients prescribed rivaroxaban and 22% lower [IRR: 0.78 (95% CI: 0.71, 0.87)] for patients prescribed apixaban, as compared to those prescribed warfarin. When comparing apixaban to rivaroxaban, there were no differences in healthcare utilization. Conclusions: VTE patients prescribed rivaroxaban and apixaban had lower healthcare utilization than did those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of direct OACs over warfarin given their similar effectiveness, slightly better safety profile, and perceived lower patient burden.

scholarly journals Revised 2004 International Classification of Headache Disorders: New Headache Types

2004 ◽  
Vol 31 (3) ◽  
pp. 304-314 ◽  
Author(s):  
Jonathan P. Gladstone ◽  
David W. Dodick
Keyword(s):  
Treatment Guidelines ◽  
International Headache Society ◽  
Genetic Research ◽  
Primary Headache ◽  
Current Treatment ◽  
International Classification ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders

In 1988, the International Headache Society created a classification system that has become the standard for headache diagnosis and research. The International Classification of Headache Disorders galvanized the headache community and stimulated nosologic, epidemiologic, pathophysiologic, and genetic research. It also facilitated multinational clinical drug trials that have led to the basis of current treatment guidelines. While there have been criticisms, the classification received widespread support by headache societies around the globe. Fifteen years later, the International Headache Society released the revised and expanded International Classification of Headache Disorders second edition. The unprecedented and rapid advances in the field of headache led to the inclusion of many new primary and secondary headache disorders in the revised classification. Using illustrative cases, this review highlights 10 important new headache types that have been added to the second edition. It is important for neurologists to familiarize themselves with the diagnostic criteria for the frequently encountered primary headache disorders and to be able to access the classification (www.i-h-s.org) for the less commonly encountered or diagnostically challenging presentations of headache and facial pain.

A Possible Role of ID-Migraine™ in the Emergency Department: Study of an Emergency Department Out-Patient Population

Cephalalgia ◽  
2009 ◽  
Vol 29 (12) ◽  
pp. 1326-1330 ◽  
Author(s):  
C Mostardini ◽  
VC d'Agostino ◽  
DE Dugoni ◽  
R Cerbo
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
High Sensitivity ◽  
High Specificity ◽  
Primary Headache ◽  
Rapid Diagnosis ◽  
Secondary Headache ◽  
Not Otherwise Specified ◽  
Id Migraine

Headache symptoms account for 1-3% of admissions to an emergency department (ED). Most patients affected by a primary headache (PH) have migraine, although they are often misdiagnosed as ‘headache not otherwise specified’. We investigated the possibility of using ID-Migraine (ID-M) to improve migraine recognition in the ED setting. We planned a pilot study involving ED out-patients with a diagnosis of PH. Diagnoses of a blinded headache expert were subsequently matched with the ID-M results. We tested ID-M on 230 patients (199 PH, 31 secondary headaches). Considering only PH, ID-M exhibited a sensitivity of 0.94 and specificity of 0.83 with a positive predictive value (PPV) of 0.99. The ID-M is a simple migraine screener with high sensitivity, high specificity and high PPV, even in an ED-derived population. Methodical use of this tool in an ED setting may, once a secondary headache has been excluded, lead to rapid diagnosis of migraine.

scholarly journals Drug-induced headache: an analysis of therapeutic strategies

2020 ◽  
Vol 12 (4) ◽  
pp. 25-31
Author(s):  
P. A. Merbaum ◽  
G. R. Tabeeva ◽  
A. V. Sergeev
Keyword(s):  
Tension Headache ◽  
Primary Headache ◽  
Developed Countries ◽  
Secondary Headache ◽  
Drug Induced ◽  
Treatment And Prevention ◽  
Symptomatic Headache ◽  
Drug Induced Headache

To manage patients with drug-induced headache (DIH) is an unsolved problem of modern neurology in developed countries, since DIH is becoming a common cause of temporary disability and leads to lower quality of life in patients. Patients with primary headache (for example, those with tension headache or migraine) frequently take symptomatic headache relief medications uncontrollably, which can result in the higher frequency and intensity of DIH episodes. In turn, new headache attacks make the patients take the increasing number of symptomatic medications, which leads to the development of DIH.The International Classification of Headache Disorders, 3 rd Edition, defines DIH as a distinct form of secondary headache. To date, there is no consensus on the tactics of DIH treatment and prevention. The paper discusses different approaches to DIH prevention and treatment, the effectiveness and appropriateness of their use, as well as factors influencing illness course and possible outcomes. Particular attention is paid to the management of patients during the withdrawal period, risk factors for DIH recurrences, and ways of their prevention.

scholarly journals Clinical availability of SNOOP4 in acute non-traumatic headache patients admitted to the emergency department

2020 ◽  
pp. 102490792092868
Author(s):  
Wachira Wongtanasarasin ◽  
Borwon Wittayachamnankul
Keyword(s):  
Emergency Department ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Primary Headache ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Sensitivity Specificity

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.

Headache in the pediatric emergency department: A 5-year retrospective study

Cephalalgia ◽  
2017 ◽  
Vol 38 (11) ◽  
pp. 1765-1772 ◽  
Author(s):  
Roberta Rossi ◽  
Antonia Versace ◽  
Barbara Lauria ◽  
Giulia Grasso ◽  
Emanuele Castagno ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cranial Nerves ◽  
Primary Headache ◽  
Pediatric Emergency ◽  
Secondary Headache ◽  
Pediatric Emergency Department ◽  
Red Flags ◽  
Exact Test ◽  
Headache Centre ◽  
Chi Squared

Aim To determine the red flags for serious organic causes of headache in children, to analyze if the management of headache in the Pediatric Emergency Department is appropriate, and whether the follow-up may limit repeated visits to the Emergency Department. Methods All the patients ≤ 18 years referred to our pediatric Emergency Department for non-traumatic headache over 5 years were retrospectively reviewed. The patients followed up by the Pediatric Headache Centre were also screened. Statistical analysis was undertaken using the Chi-squared test or Fisher’s exact test and multivariate analysis; significance at p < 0.05. Results 1833 patients (54.6% males) accessed our Emergency Department 2086 times; 62.1% had primary headache, 30.0% had secondary headache, 7.8% received inconsistent diagnosis. Among those with secondary headache, 24 (1.1% of total visits) were diagnosed with serious disorders. The clinical red flags for “serious headache” were: Cranial nerves palsy, strabismus, and drowsiness. One hundred and eighty four patients (8.8 %) underwent neuroimaging (rate of pathological findings: 7.1 %); 37.2 % of the patients received analgesic therapy. One hundred and fifteen patients (6.2 %) returned within three months; 24 of these were referred to the Headache Centre, with only one accessing the Emergency Department again. Conclusions The vast majority of headaches referred to the Pediatric Emergency Department are benign, and primary forms prevail. “Serious headache” is rare and shows typical clinical features and abnormal neurologic evaluation; specific clinical red flags, along with suggestive personal history, should lead the pediatrician to prescribe only appropriate neuroimaging. Pain relief is still insufficient in the Pediatric Emergency Department despite appropriate guidelines. Last, the collaboration with the Headache Centre is crucial to limit repeated visits.

scholarly journals Headaches: new classification, clinical and diagnostic criteria in General Medicine

2014 ◽  
Vol 8 (3) ◽  
pp. 67-74
Author(s):  
Linda Iurato
Keyword(s):  
International Headache Society ◽  
General Medicine ◽  
Primary Headache ◽  
Secondary Headache ◽  
Headache Disorders ◽  
First Line ◽  
Primary Headache Disorders ◽  
Headache Diagnosis ◽  
Beta Version

The classification system of headaches is one of the oldest in medicine, and includes a hugeamount of types and causes. The International Headache Society has listed two broad categoriesfor headache disorders: primary headache disorders, which lack a clear underlying causativepathology, and secondary headache disorders, that have a known cause. This is an overviewaddressed to general practitioners to help making a first-line headache diagnosis basing on themost common types of headache listed in the 2013 International Classification of Headachedisorder 3rd edition (beta version). Although headache diagnosis and treatment have madesubstantial gains in the last decade, the disease is still underdiagnosed and undertreated:improvements in several areas are required, especially in General Medicine.

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