scholarly journals Management of Primary Headache in the Emergency Department

2020 ◽  
Author(s):  
Richard Pescatore
Keyword(s):  
Emergency Department ◽  
Symptom Relief ◽  
Disease Process ◽  
Primary Headache ◽  
Overwhelming Majority ◽  
Diagnostic Process ◽  
Primary Headaches ◽  
Emergency Setting ◽  
Headache Management ◽  
Headache Patients

Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.‎1 While the overwhelming majority of patients present with a primary headache disorder, particularly migraine, the emergency physician’s role calls for the simultaneous exclusion of severe or life-threatening pathology while providing judicious and effective symptom relief.‎2 Notably, recent investigations suggest that this dual mandate performs well, excluding more than 99% of conditions resulting in serious adverse neurologic sequelae, though at the cost of high-frequency and low-yield advanced imaging utilization.‎3‎, 4 While a comprehensive understanding of the diagnostic process and underlying pathophysiology associated with headache disorders is critical for the emergency clinician, this review is meant to chiefly describe the treatment of primary headache and the variety, efficacy, and indications of those interventions. While individual headache type classification can be helpful in targeting approach or therapy, diagnosis can be difficult in the emergency setting, and primary headaches of most types are often approached similarly in the ED. Interestingly, the overwhelming majority of patients who present to an emergency department with acute primary headache have migraine, but the majority of patients receive a less specific diagnosis and a treatment that is correspondingly nonspecific.‎5 Importantly, however, the dynamic, diverse, and unique nature of different headache presentations to the ED make an algorithmic or step-wise approach to headache management ill-advised. The emergency practitioner must have a working knowledge of the array of treatment options available and apply therapies in a considered and informed manner. Following effective analgesia, however, the most important intervention emergency physicians can deliver for their headache patients is to connect them with outpatient physicians savvy about headache management, who will then provide these headache patients with appropriate acute therapeutics, initiate preventive therapy and provide anticipatory guidance about their disease process.‎6

scholarly journals Management of Primary Headache in the Emergency Department

2020 ◽  
Author(s):  
Richard Pescatore
Keyword(s):  
Emergency Department ◽  
Symptom Relief ◽  
Disease Process ◽  
Primary Headache ◽  
Overwhelming Majority ◽  
Diagnostic Process ◽  
Primary Headaches ◽  
Emergency Setting ◽  
Headache Management ◽  
Headache Patients

Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.‎ While the overwhelming majority of patients present with a primary headache disorder, particularly migraine, the emergency physician’s role calls for the simultaneous exclusion of severe or life-threatening pathology while providing judicious and effective symptom relief.‎ Notably, recent investigations suggest that this dual mandate performs well, excluding more than 99% of conditions resulting in serious adverse neurologic sequelae, though at the cost of high-frequency and low-yield advanced imaging utilization.‎ While a comprehensive understanding of the diagnostic process and underlying pathophysiology associated with headache disorders is critical for the emergency clinician, this review is meant to chiefly describe the treatment of primary headache and the variety, efficacy, and indications of those interventions. While individual headache type classification can be helpful in targeting approach or therapy, diagnosis can be difficult in the emergency setting, and primary headaches of most types are often approached similarly in the ED. Interestingly, the overwhelming majority of patients who present to an emergency department with acute primary headache have migraine, but the majority of patients receive a less specific diagnosis and a treatment that is correspondingly nonspecific.‎ Importantly, however, the dynamic, diverse, and unique nature of different headache presentations to the ED make an algorithmic or step-wise approach to headache management ill-advised. The emergency practitioner must have a working knowledge of the array of treatment options available and apply therapies in a considered and informed manner. Following effective analgesia, however, the most important intervention emergency physicians can deliver for their headache patients is to connect them with outpatient physicians savvy about headache management, who will then provide these headache patients with appropriate acute therapeutics, initiate preventive therapy and provide anticipatory guidance about their disease process.‎

scholarly journals Clinical features, diagnosis and treatment of acute primary headaches at an emergency center: why are we still neglecting the evidence?

2007 ◽  
Vol 65 (4b) ◽  
pp. 1130-1133 ◽  
Author(s):  
Facundo Burgos Ruiz Jr ◽  
Márcia Silva Santos ◽  
Helen Souto Siqueira ◽  
Ulisses Correa Cotta
Keyword(s):  
Clinical Features ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Main Diagnosis ◽  
Management Protocol ◽  
Headache Management ◽  
Probable Migraine ◽  
Type Headache ◽  
Acute Headache

In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.

L-5HTP Treatment in Primary Headaches: An Attempt at Clinical Identification of Responsive Patients

Cephalalgia ◽  
1984 ◽  
Vol 4 (3) ◽  
pp. 159-165 ◽  
Author(s):  
Giorgio Bono ◽  
Giuseppe Micieli ◽  
Grazia Sances ◽  
Menotti Calvani ◽  
Giuseppe Nappi
Keyword(s):  
Lower Incidence ◽  
Therapeutic Response ◽  
Positive Response ◽  
Primary Headache ◽  
Primary Headaches ◽  
Activity Profile ◽  
Trigger Factors ◽  
Associated Symptoms ◽  
Headache Patients

The therapeutic response to L-5HTP, a serotonin precursor, was studied in an attempt to identify clinical subgroups of primary headache patients. The results at the 4th month control in 100 patients under L-5HTP treatment at the dose of 300 mg/day confirm previous observations on the activity profile of the drug, the effects of which are equally distributed between recurrent and daily forms as well as among clinical subtypes. The emerging profile of the responsive patients is characterized by such peculiar traits as prevalence of previous major mood disturbances and minor frequency of anxiety, longer duration of the illness and higher occurrence of some associated symptoms, lower incidence of exogenous and hormonal trigger factors, and previously positive response to pizotifen treatment.

Approach to primary headache patients in the emergency department of a tertiary hospital

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sonia Quintas ◽  
Alba Somovilla ◽  
Carlos Hervás ◽  
Jaime Alonso ◽  
Ana Beatriz Gago-Veiga
Keyword(s):  
Emergency Department ◽  
Primary Headache ◽  
Tertiary Hospital ◽  
Headache Patients

A Study of Clinical Features and Risk Factors of Self-Referring Emergency Department Headache Patients: A Comparison with Headache Center Outpatients

2020 ◽  
Vol 83 (1) ◽  
pp. 34-40
Author(s):  
Alessandro Viganò ◽  
Ersilia Savastano ◽  
Barbara Petolicchio ◽  
Massimiliano Toscano ◽  
Rita De Sanctis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Clinical Features ◽  
Statistical Models ◽  
Function Analysis ◽  
Time Interval ◽  
Emergency Setting ◽  
Negative Consequences ◽  
Headache Patients

Background: Nonlife-threatening headaches account for 3% of emergency department (ED) admissions, with social and economic negative consequences. We aim to investigate clinical features and risk factors of nonlife-threatening headache patients referring to ED versus those referring to headache outpatient clinics. Methods: During 6 months, we promptly reevaluated in our headache unit (HU) patients discharged from ED. We compared the clinical characteristics of patients who referred to ED with those of HU outpatients visited in the same time interval. Discriminant Function Analysis and Correspondence Analysis were used to determine risk factors for ED referral. Results: We recruited 49 post-ED patients and 126 outpatients. The main reasons for ED admission were poor response to acute treatment and aura-related symptoms. Headache diagnoses made in ED were generally not confirmed later (overall concordance of 47%), except for cluster headache (CH) and migraine with aura (MA). ED patients complained higher headache intensity, longer duration, and prolonged aura compared to outpatients. Aura was the main risk factor associated with ED admission on statistical models, while less prominent risk factors were sex, age, and years from migraine onset. Conclusions: ED patients presented a more severe headache clinical phenotype compared with outpatients. Headache diagnosis remains difficult in the emergency setting and is more easily achieved for the headache forms with standout features, such as MA or CH. According to statistical models, the aura is the most important risk factor for ED admissions.

scholarly journals Management of primary headache in emergency services of Santos and surrounding towns

1998 ◽  
Vol 116 (2) ◽  
pp. 1650-1653 ◽  
Author(s):  
Yara Dadalti Fragoso ◽  
Priscilla Lopes da Fonseca ◽  
Marcelo Bougartner Fortinguerra ◽  
Louise Cominato ◽  
Guilherme de Oliveira Matte ◽  
...  
Keyword(s):  
Emergency Services ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Medical Doctors ◽  
Double Blind ◽  
High Prevalence ◽  
Headache Management ◽  
Type Headache ◽  
The City

OBJECTIVES: Primary headaches are often seen by Clinicians on duty at Emergency Services. We have investigated the treatment of such patients by 43 medical doctors who have been working at Emergency Services in the city of Santos and surrounding towns for many years. RESULTS: We confirmed the high prevalence of primary headaches in Emergency Services. There seem to be diagnosis difficulties concerning differentiating attacks of migraine and tension type headache. We also observed that IV dipirone was the most frequently prescribed treatment for patients with primary headaches in this study. There is no protocol in the literature which recommends IV dipirone for the treatment of migraine attacks or other primary headaches. CONCLUSION: It would be advisable to perform controlled double blind studies in order to verify the advantages of IV dipirone in the treatment of intense attacks primary headaches. We concluded that headache management recycling programs could be of interest for doctors who regularly work at Emergency Services.

Recommendations for the management of headaches during the COVID-19 pandemic

2020 ◽  
pp. 48-50
Author(s):  
Yara Dadalti Fragoso ◽  
Marcelo Calderaro ◽  
Marcio Nattan Portes Souza ◽  
Patrick Emanuell Mesquita Sousa Santos ◽  
Eduardo Nogueira ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Primary Headache ◽  
Urgent Care ◽  
Primary Headaches ◽  
The Novel ◽  
Treatment Optimization ◽  
Headache Patient ◽  
Care Systems ◽  
Headache Management ◽  
Novel Coronavirus

BackgroundDuring the novel coronavirus - COVID-19 pandemic, health care systems are facing one of its greatest challenges.ResultsSecondary headaches may need urgent care at an emergency department. Primary headaches exacerbations may require intravenous infusion. Treatment optimization is key for a better outpatient management.ConclusionWe give recommendations on when a headache patient should go to the hospital despite the current limited resources, and primary headache management aspects during the outbreak.

scholarly journals Osmophobia in primary headache patients: associated symptoms and response to preventive treatments

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marianna Delussi ◽  
Anna Laporta ◽  
Ilaria Fraccalvieri ◽  
Marina de Tommaso
Keyword(s):  
Cluster Headache ◽  
Rating Scale ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Self Rating ◽  
Type Headache ◽  
Headache Center ◽  
Headache Patients

Abstract Background Osmophobia, is common among primary headaches, with prevalence of migraine. The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients. Methods This was an observational retrospective cohort study based on data collected in a tertiary headache center. We selected patients aged 18–65 years, diagnosed as migraine without aura (MO), migraine with aura (MA) or Chronic Migraine (CM), Tension-Type Headache (TTH); and Cluster Headache (CH). We also selected a sub-cohort of migraine patients who were prescribed preventive treatment, according to Italian Guidelines, visited after 3 months follow up. Patients were considered osmophobic, if reported this symptom in at least the 20% of headache episodes. Other considered variables were: headache frequeny, the migraine disability assessment (MIDAS), Allodynia Symptom Checklist, Self-rating Depression scale, Self-rating Anxiety scale, Pain intensity evaluated by Numerical Rating Scale-NRS- form 0 to 10. Results The 37,9% of patients reported osmophobia (444 patients with osmophobia, 726 without osmophobia). Osmophobia prevailed in patients with the different migraine subtypes, and was absent in patients with episodic tension type headache and cluster headache (chi square 68.7 DF 7 p < 0.0001). Headache patients with osmophobia, presented with longer hedache duration (F 4.91 p 0.027; more severe anxiety (F 7.56 0.007), depression (F 5.3 p 0.019), allodynia (F 6 p 0.014), headache intensity (F 8.67 p 0.003). Tension type headache patients with osmophobia (n° 21), presented with more frequent headache and anxiety. A total of 711 migraine patients was visited after 3 months treatment. The change of main migraine features was similar between patients with and without osmophobia. Conclusions While the present study confirmed prevalence of osmophobia in migraine patients, it also indicated its presence among chronic tension type headache cases, marking those with chronic headache and anxiety. Osmophobia was associated to symptoms of central sensitization, as allodynia. It was not relevant to predict migraine evolution after first line preventive approach.

Diet and nutraceutical interventions for headache management: A review of the evidence

Cephalalgia ◽  
2016 ◽  
Vol 36 (12) ◽  
pp. 1112-1133 ◽  
Author(s):  
Serena L Orr
Keyword(s):  
Primary Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Cochrane Central Register ◽  
Primary Headache Disorders ◽  
Alternative Medicines ◽  
Central Register ◽  
Headache Management ◽  
Type Headache

Background The use of complementary and alternative medicines (CAM) is common among patients with primary headaches. In parallel, CAM research is growing. Diet interventions comprise another category of non-pharmacologic treatment for primary headache that is of increasing clinical and research interest. Methods A literature search was carried out to identify studies on the efficacy of diet and nutraceutical interviews for primary headache in the pediatric and adult populations. MEDLINE, Embase and EBM Reviews—Cochrane Central Register of Controlled Trials were searched to identify studies. Results There is a growing body of literature on the potential use of CAM and diet interventions for primary headache disorders. This review identified literature on the use of a variety of diet and nutraceutical interventions for headache. Most of the studies assessed the efficacy of these interventions for migraine, though some explored their role in tension-type headache and cluster headache. The quality of the evidence in this area is generally poor. Conclusions CAM is becoming more commonplace in the headache world. Several interventions show promise, but caution needs to be exercised in using these agents given limited safety and efficacy data. In addition, interest in exploring diet interventions in the treatment of primary headaches is emerging. Further research into the efficacy of nutraceutical and diet interventions is warranted.

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