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

2021 ◽  
Vol 12 ◽  
Author(s):  
Cynthia M. C. Lemmens ◽  
M. Christien van der Linden ◽  
Korné Jellema
Keyword(s):  
Emergency Department ◽  
Diagnostic Imaging ◽  
Ct Imaging ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Focal Neurological Deficit ◽  
Cranial Ct ◽  
Imaging Results ◽  
Headache Onset ◽  
Headache Patients

Background: Headache is among the most prevalent complaints in patients presenting to the emergency department (ED). Clinicians are faced with the difficult task to differentiate primary (benign) from secondary headache disorders, since no international guidelines currently exist of clinical indicators for neuroimaging in headache patients.Methods: We performed a retrospective review of 501 patients who presented at the ED with headache as a primary complaint between April 2018 and December 2018. Primary outcomes included the amount of diagnostic imaging, the different conclusions provided by diagnostic imaging, and the clinical factors associated with abnormal imaging results.Results: About half of the patients were diagnosed with a primary headache disorder. Cranial CT imaging at the ED was performed regularly (61% of the patients) and led to the diagnosis of underlying pathology in 1 in 7.6 patients. In a multivariate model, factors significantly associated with abnormal cranial CT results were age 50 years or older, presentation within 1 h after headache onset, clinical history of aphasia, and focal neurological deficit at examination.Conclusions: As separate clinical characteristics have limited value in detecting severe underlying headache disorders, cranial imaging is regularly performed in the ED. Clinical prediction model tools applied to headache patients may identify patients at risk of intracranial pathology prior to diagnostic imaging and reduce cranial imaging in the future.

Triage bei Kopfschmerz in der Hausarztpraxis: Wann einweisen?

2019 ◽  
Vol 144 (10) ◽  
pp. 651-658
Author(s):  
Solveig Carmienke ◽  
Dagny Holle-Lee
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioner ◽  
Hospital Care ◽  
Secondary Headache ◽  
Red Flags ◽  
Secondary Headaches ◽  
Specialist Treatment ◽  
Yellow Flags ◽  
Headache Patients

AbstractHeadache is one of patients’ most common reasons to consult their general practitioner and covers about 2 – 5 % of the consultations in primary care. Often, the general practitioner is the first to be contacted by patients with headache. Mostly, headaches are primary and only 2 % of the patients have secondary headaches. The distinction between primary and secondary headache is the most important step in the management of patients with headache in primary care. Therefore, this article shows important elements of anamnesis and examination of headache patients in primary care. Furthermore, this article focuses on identification of red flags and yellow flags in the consultation of patients with headache and suggests recommendations for referral to emergency department, hospital care or specialist treatment.

scholarly journals Young Male With Recurrent Headache: A Case Report

2020 ◽  
Author(s):  
Yu-Ta Chien ◽  
Shang-Yu Feng
Keyword(s):  
Emergency Department ◽  
Young Male ◽  
Sudden Onset ◽  
Secondary Headache ◽  
Neck Stiffness ◽  
Focal Neurological Deficit ◽  
Case Presentation ◽  
Computed Tomographic ◽  
Acute Meningitis ◽  
Headache Therapy

Abstract Background Headache, one of the most common symptoms presenting to the emergency department, is usually benign but sometimes fatal. Identifying high-risk headache syndromes and providing appropriate headache therapy remain the first priority for emergency physicians. Common “Red flags” includes sudden onset, focal neurological deficit, fever, neck stiffness and so on. We categorize headache into primary (such as tension, cluster headache and migraine) and secondary (subarachnoid hemorrhage, acute meningitis, intracranial hemorrhage, etc) while ruling out secondary headache is the first step in management. Case presentation We report a case of nasopharyngeal carcinoma(NPC) with defect at left side of nasopharynx and sphenoid sinus causing diffuse pneumocephalus. The 35-year-old male presented to the emergency department for sudden-onset headache with unusual associated symptom: rhinorrhea. Computed tomographic (CT) examination revealed a diffuse pneumocephalus, which did not present in magnetic resonance imaging of brain one month ago. The treatment was mainly conservative and the recovery was smooth.Conclusions Unusual symptoms like rhinorrhea and otorrhea should not be ignored, they might be the only clues to the diagnosis of pneumocephalus. Most of the pneumocephalus related to NPC occurred after recent radiotherapy. However, this patient finished radiotherapy on 2012/5. Thus, metastatic skull bony erosion with associated pneumocephalus might be taken into consideration.

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.

scholarly journals MP25: The role of advanced imaging in the management of benign headaches in the emergency department: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S73 ◽  
Author(s):  
R. Lepage ◽  
L. Krebs ◽  
S.W. Kirkland ◽  
C. Alexiu ◽  
S. Campbell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Ct Scans ◽  
Secondary Headache ◽  
Advanced Imaging ◽  
Ct Utilization ◽  
Weighted Median ◽  
Ct Head ◽  
Study Population ◽  
Headache Patients

Introduction: Headache is a common emergency department (ED) presentation. Benign (i.e., non-pathological) headaches are particularly common, including exacerbations of chronic migraine, tension, and cluster headache. Several studies have reported concerns over the frequent use of advanced imaging, specifically computed tomography (CT), in the ED management of benign or primary headache presentations. This systematic review examined the proportion of adult ED benign headache presentations who receive a CT(head). Methods: Eight bibliographic databases and the grey literature were searched. All studies reporting the proportion of benign headache patients receiving a CT(head) in the ED were eligible for inclusion. Studies which included a secondary headache population of 15% of their total study population or less where eligible for inclusion. Two reviewers independently assessed study inclusion and completed quality assessment and data extraction. Weighted medians were calculated for the primary and secondary outcomes, as appropriate. Results: The search returned 2,444 unique citations, of which 20 met the inclusion criteria (21 patient groups were analyzed). The majority of the studies were descriptive in nature and conducted in North America. The reported proportion of benign headache patients receiving a CT(head) varied considerably (range: 2.06-67.21%); with a weighted median of 30.0% (interquartile range: 30.0, 30.0). Studies published in 2000 or later (18/21 groups) were found to have a higher weighted median percentage compared to those published pre-2000 (p=0.016). Neither the country of origin nor the proportion of patients with secondary headache included within the study population had a significant effect on CT utilization. Of the three studies which reported the discharge diagnosis of all patients, sub-arachnoid hemorrhage was discovered in 2/241 (0.83%) of CT scans. Conclusion: Considerable variation in CT utilization for benign headache ED presentations exists and estimates indicate that more than a quarter of patients receive a CT(head). Overall, these CT scans rarely identify significant pathology, suggesting imaging may be safely reduced. Further research is required to identify interventions which can safely and effectively reduce unnecessary imaging among headache presentations.

scholarly journals Characteristics of headache disorders, according to ICHD-III in an outpatient headache clinic in Sohag Governorate, Egypt

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Al-Amir Bassiouny Mohamed
Keyword(s):  
Medication Overuse Headache ◽  
Primary Headache ◽  
Cranial Neuropathy ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Cross Sectional ◽  
Female Ratio ◽  
Primary Headache Disorders ◽  
Headache Clinic ◽  
Headache Patients

Abstract Background Headache disorders are rated among the ten most disabling conditions around the world. The primary headache disorders are more common that of secondary headache. The third edition of the International Classification of Headache Disorders (ICHD-III) is considered as a helpful tool for classification and diagnosis of different headache disorders. Methods This is a cross-sectional study that included 500 patients who attended to the headache clinic, between May 2018 and April 2019. Arabic version of headache questionnaire was used to characterize headache, according to ICHD-III. Results Primary headache disorders were found in 89% (most of them is episodic in nature 76.2%), secondary headache disorders in about 10%, and painful cranial neuropathy was present in 0.8%. Primary headache associated with sexual activity was present in 1% of the total number of headache patients, and episodic cluster headache was found in 0.8%. Medication overuse headache (MOH) was the most frequent secondary headache with 2.8% of the total number of headache patients, and when overlaps with chronic migraine or chronic tension type of headache (TTH), the percent was 12.8% and 8.8% respectively. Male to female ratio was 1:3, 3:5, and 1:1 in primary headache, secondary headache, and painful cranial neuropathy respectively. Simple analgesia was the most common abortive therapy (44.8%) while the antidepressants were the most common preventive treatment (17%). Conclusion This study estimates the frequency and characterizes different headache disorders, according to ICHD-III in an outpatient headache clinic at Sohag Governorate, Egypt.

scholarly journals Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Henrik W. Schytz ◽  
Faisal M. Amin ◽  
Rigmor H. Jensen ◽  
Louise Carlsen ◽  
Stine Maarbjerg ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Primary Care Physicians ◽  
Facial Pain ◽  
Common Interest ◽  
Diagnosis And Treatment ◽  
Primary Headaches ◽  
Secondary Headache ◽  
Great Success ◽  
Headache Disorders

AbstractHeadache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well as other health-care professionals treating headache patients. The guideline first describes how to examine and diagnose the headache patient and how headache treatment is organized in Denmark. This description is followed by sections on the characteristics, diagnosis and treatment of each of the most common primary and secondary headache disorders and trigeminal neuralgia. The guideline includes many tables to facilitate a quick overview. Finally, the particular challenges regarding migraine and female hormones as well as headache in children are addressed.

scholarly journals Multisite medical record review of emergency department visits for traumatic brain injury

2021 ◽  
Vol 27 (S1) ◽  
pp. i42-i48
Author(s):  
Barbara A Gabella ◽  
Jeanne E Hathaway ◽  
Beth Hume ◽  
Jewell Johnson ◽  
Julia F Costich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Skull Fracture ◽  
Signs And Symptoms ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Intracranial Injury ◽  
Imaging Results ◽  
Icd 10

BackgroundIn 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.MethodsFour study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).ResultsPPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.DiscussionICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

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