Headache diagnosis in an urgency and emergency unit: Public Health Relevance and its relationship with cost

BackgroundHeadache is a common symptom that affects a significant portion of the general population. It constitutes a challenge for diagnosis in urgency and emergency care services, due to headache’s clinical variability and diverse possible etiologies, besides the limited time and resources of these facilities. Because of this insufficiency and the potential severity associated with the condition, headaches generate considerable expenditures to health systems, related to both diagnostic discrimination and treatment.ObjectiveEvaluating the diagnostic resources used on headache patients care, as well as its Public Health Relevanceand relation to cost in an Emergency and Urgency Care unit.MethodsCross-section study analyzing 450 medical records of patients with headache complaints in the time frame from January 1, 2019, and December 31, 2019. Patients were categorized according to the type of headache (primary and secondary), specialized evaluation, complementary exams used in the diagnosis, hospital observation time, and the final expenditure in each patient’s care.ResultsThe total estimated expenditures related to headache care equaled US$90,855.60 (average US$201.90 per patient). 38.9% of cases corresponded to primary headaches and 31.1% to secondary headaches. 30% of cases could not be classified. The resources utilized for secondary headaches diagnosis differed significantly from those used in primary headache diagnosis. However, the final expenditures were similar to both groups.ConclusionThe socio-economic impact caused by headaches is unquestionable. It is a highly frequent symptom and both its etiological distinction and adequate treatment require solid evaluation. Due to the resources spent in its evaluation and monitoring, headaches can be considered a public health problem. Therefore, this study suggests that resources should be allocated in the health education and professional training for the proper conduction of these patients, so that they may benefit from an optimized treatment of theircondition without overwhelming the health system.

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Primary headaches in obese patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2005000600005 ◽

2005 ◽

Vol 63 (4) ◽

pp. 931-933 ◽

Cited By ~ 34

Author(s):

Mario Fernando Prieto Peres ◽

Daniel Diniz Gonçalves Lerário ◽

Arthur Belarmino Garrido ◽

Eliova Zukerman

Keyword(s):

Public Health ◽

Body Mass Index ◽

Public Health Problem ◽

Tension Type Headache ◽

Primary Headaches ◽

Major Public Health Problem ◽

Obese Patients ◽

Headache Disorders ◽

Headache Diagnosis ◽

Type Headache

BACKGROUND AND OBJECTIVE: Obesity is a major public health problem worldwide. Little is known about the prevalence and impact of headache disorders in obese patients. The objective of this study was to assess the prevalence of primary headaches in obese patients and controls. METHOD: Seventy-four consecutive obese patients from the obesity surgery service were studied, and compared to controls with body mass index less than 25. RESULTS: Fifty-six patients (75%) had a headache diagnosis, 49 migraine (66%), 7 tension-type headache (9%), 36 (48%) had incapacitating headaches. CONCLUSION: Primary headaches are more common and incapacitating in obese patients than controls, migraine is the most important diagnosis in this population. Headaches should be properly diagnosed and treated in obese patients.

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Automatic diagnosis of primary headaches by machine learning methods

Open Medicine ◽

10.2478/s11536-012-0098-5 ◽

2013 ◽

Vol 8 (2) ◽

pp. 157-165 ◽

Cited By ~ 16

Author(s):

Bartosz Krawczyk ◽

Dragan Simić ◽

Svetlana Simić ◽

Michał Woźniak

Keyword(s):

Machine Learning ◽

Negative Impact ◽

Life Quality ◽

Primary Headache ◽

Machine Learning Techniques ◽

Future Research ◽

Common Disease ◽

Primary Headaches ◽

Starting Point ◽

Headache Diagnosis

AbstractPrimary headaches are common disease of the modern society and it has high negative impact on the productivity and the life quality of the affected person. Unfortunately, the precise diagnosis of the headache type is hard and usually imprecise, thus methods of headache diagnosis are still the focus of intense research. The paper introduces the problem of the primary headache diagnosis and presents its current taxonomy. The considered problem is simplified into the three class classification task which is solved using advanced machine learning techniques. Experiments, carried out on the large dataset collected by authors, confirmed that computer decision support systems can achieve high recognition accuracy and therefore be a useful tool in an everyday physician practice. This is the starting point for the future research on automation of the primary headache diagnosis.

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Headache

10.2310/em.4174 ◽

2018 ◽

Author(s):

Benjamin W Friedman

Keyword(s):

Differential Diagnosis ◽

Clinical Characteristics ◽

Sinus Thrombosis ◽

International Headache Society ◽

Primary Headache ◽

Primary Headaches ◽

Key Words Migraine ◽

Secondary Headaches ◽

Primary Headache Disorders ◽

Greater Occipital Nerve

Headaches are one of the most common complaints of patients seen by emergency physicians. They can be classified as primary headaches, which have no identifiable underlying cause, and secondary headaches, which are classified according to their cause. The majority of headaches are benign in origin, and most patients with headache can be treated successfully in the emergency department and discharged home; however, some have potentially life-threatening causes, and consideration of a broad differential diagnosis for all patients is essential. This review covers the primary headache disorders, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes. The figure shows areas of the brain sensitive to pain. Tables review differential diagnosis of headache, International Headache Society primary headache criteria, clinical characteristics of secondary headaches, high-risk clinical characteristics among patients with a headache peaking in intensity within 1 hour, drugs associated with headache, and parenteral treatment of acute migraine. This review contains 1 figure, 9 tables, and 58 references. Key words: migraine, calcitonin gene related peptide, greater occipital nerve block, venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, Ottawa, subarachnoid, cluster headache, trigeminal autonomic cephalalgias, post-traumatic headache

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Whiplash Headache is Transitory Worsening of a Pre-Existing Primary Headache

Cephalalgia ◽

10.1111/j.1468-2982.2008.01615.x ◽

2008 ◽

Vol 28 (1_suppl) ◽

pp. 28-31 ◽

Cited By ~ 14

Author(s):

LJ Stovner ◽

D Obelieniene

Keyword(s):

Neck Pain ◽

Primary Headache ◽

Control Group ◽

Primary Headaches ◽

Headache Diagnosis ◽

Police Records ◽

Characteristic Features ◽

Long Term Prognosis ◽

Chronic Whiplash

Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.

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A study on clinical profile of typhoid fever in children

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171730 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1067

Author(s):

Ranganatha A. Devaranavadagi ◽

Srinivasa S.

Keyword(s):

Public Health ◽

Typhoid Fever ◽

Clinical Manifestations ◽

Antibiotic Sensitivity ◽

Public Health Problem ◽

Public Health Issue ◽

Common Symptom ◽

Major Public Health Problem ◽

Sensitivity Pattern ◽

Wide Range

Background: Typhoid fever is caused by Salmonella typhi. It is a major public health problem in India. Typhoid fever is endemic in many developing countries. Wide variations in the clinical manifestations of typhoid fever make its diagnosis a challenging task. This study was conducted to understand the wide range of clinical manifestations, complications and antibiotic sensitivity patterns of typhoid fever in children.Methods:Prospectively, 113 children admitted in pediatric unit with confirmed Typhoid fever from September 2015 to December 2016 at KIMS hospital, Bangalore were included. In each case, age, sex, presenting complaint, laboratory investigations and antibiotic sensitivity pattern are collected and analysed.Results: Out of 113 cases, 72 cases (63.8.1%) were males, 41 cases (36.2%) were females. The most common age group was 5-10 years. The most common symptom was fever, seen in 100% cases, followed by anorexia (61%), vomiting (44%) and abdominal pain (18%). The most common sign observed was toxic look in 68% of the cases, followed by coated tongue in 49% and hepatomegaly in 44%. Leucocytopenia was found in 34% of cases. Eosinopenia was found in 39% of cases. Anaemia was found in 16% of cases. Thrombocytopenia was found in 15% of cases. Blood culture was positive in 20% of cases. Use of municipal water for drinking was found in 65% of cases. Outside eating was found in 40% of cases. Unhygienic practices were found in 64% of cases. Duration of hospital stay varied from 3-10 days. No mortality reported.Conclusions:Typhoid fever is most commonly observed with unhygienic practices and eating of unhealthy outside food. This major public health issue can be tackled by bringing awareness among people regarding disease transmission and its various preventive measures.

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Chagas Cardiomyopathy Presenting as Symptomatic Bradycardia: An Underappreciated Emerging Public Health Problem in the United States

Case Reports in Cardiology ◽

10.1155/2017/5728742 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Richard Jesse Durrance ◽

Tofura Ullah ◽

Zulekha Atif ◽

William Frumkin ◽

Kaushik Doshi

Keyword(s):

Public Health ◽

United States ◽

Latin American ◽

Endemic Area ◽

Sinus Bradycardia ◽

Public Health Problem ◽

The United States ◽

Adequate Treatment ◽

Chagas Cardiomyopathy ◽

Latin American Immigrants

Chagas cardiomyopathy (CCM) is traditionally considered a disease restricted to areas of endemicity. However, an estimated 300,000 people living in the United States today have CCM, of which its majority is undiagnosed. We present a case of CCM acquired in an endemic area and detected in its early stage. A 42-year-old El Salvadoran woman presented with recurrent chest pain and syncopal episodes. Significant family history includes a sister in El Salvador who also began suffering similar episodes. Physical exam and ancillary studies were only remarkable for sinus bradycardia. The patient was diagnosed with symptomatic sinus bradycardia and a pacemaker was placed. During her hospital course, Chagas serology was ordered given the epidemiological context from which she came. With no other identifiable cause, CCM was the suspected etiology. This case highlights the underrecognized presence of Chagas in the United States and the economic and public health importance of its consideration in the etiological differential diagnosis of electrocardiographic changes among Latin American immigrants. While the United States is not considered an endemic area for Chagas disease, the influx of Latin American immigrants has created a new challenge to identify at-risk populations, diagnose suspected cases, and provide adequate treatment for this disease.

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Headache in Behçet's Disease

Cephalalgia ◽

10.1111/j.1468-2982.2005.01017.x ◽

2006 ◽

Vol 26 (2) ◽

pp. 180-186 ◽

Cited By ~ 23

Author(s):

E Aykutlu ◽

B Baykan ◽

G Akman-Demir ◽

B Topcular ◽

M Ertas

Keyword(s):

Behçet’S Disease ◽

Systemic Inflammation ◽

Behcet’S Disease ◽

Behçet's Disease ◽

International Headache Society ◽

Primary Headache ◽

Neurological Involvement ◽

Primary Headaches ◽

Behcet's Disease ◽

Secondary Headaches

The aim of this study was to investigate the characteristics of headache in patients with Behçet's disease (BD) seeking neurological consultation. Consecutive patients with BD seen within 1 year at the neuro-Behçet's out-patient clinic were studied using an electronic database according to the classification criteria of the International Headache Society. During a 12-month period 118 BD patients were admitted, and 98 had headaches. Migraine was the most common type of primary headache diagnosed in 45 patients (46.4%) in the whole headache group, followed by tension-type headache (TTH) in 26 cases (26.8%). Thirty-seven patients had secondary headaches mainly due to cerebral venous thrombosis or parenchymal neurological involvement of BD. Of these patients, 15 had both primary and secondary headaches. The primary headaches of 13 patients were exacerbated with systemic BD flare-ups, and four patients had migraine attacks triggered only by systemic BD activation which showed a good response to the treatment of systemic inflammation. The majority of the headaches of patients with BD do not indicate any neurological involvement; they are usually due to migraine or TTH. In a minority of patients, migraine associated with systemic inflammation of BD is notable.

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Outbreaks of infectious disease associated with private drinking water supplies in England and Wales 1970–2000

Epidemiology and Infection ◽

10.1017/s0950268803008495 ◽

2003 ◽

Vol 130 (3) ◽

pp. 469-479 ◽

Cited By ~ 69

Author(s):

B. SAID ◽

F. WRIGHT ◽

G. L. NICHOLS ◽

M. REACHER ◽

M. RUTTER

Keyword(s):

Public Health ◽

Infectious Disease ◽

Drinking Water ◽

Public Health Problem ◽

Water Supplies ◽

Adequate Treatment ◽

England And Wales ◽

The Public ◽

Main Factors ◽

Heavy Rains

In England and Wales over the last 30 years there have been 25 reported outbreaks of infection, associated with private water supplies (PWS). The majority (16 outbreaks) were reported after the introduction of enhanced surveillance. Although PWS only serve 0·5% of the population, 36% of drinking water outbreaks are associated with PWS. The main pathogen, campylobacter, was implicated in 13 (52%) outbreaks. Most reported outbreaks (88%) occurred in commercial or Category Two supplies, which potentially affect larger populations. The main factors implicated in these outbreaks are temporary or transient populations, treatment (lack or failure), the presence of animals and heavy rains. The public health problem associated with PWS could be prevented by the identification and understanding of risk factors, by the proper protection of water sources and adequate treatment and maintenance. This could be facilitated through the introduction of a risk assessment as part of a scheme for PWS.

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Headache

10.2310/fm.4174 ◽

2018 ◽

Author(s):

Benjamin W Friedman

Keyword(s):

Differential Diagnosis ◽

Clinical Characteristics ◽

Sinus Thrombosis ◽

International Headache Society ◽

Primary Headache ◽

Primary Headaches ◽

Key Words Migraine ◽

Secondary Headaches ◽

Primary Headache Disorders ◽

Greater Occipital Nerve

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Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp20x710417 ◽

2020 ◽

Vol 70 (696) ◽

pp. e514-e522

Author(s):

Alina Buture ◽

Fayyaz Ahmed ◽

Yachna Mehta ◽

Koen Paemeleire ◽

Peter J Goadsby ◽

...

Keyword(s):

Cluster Headache ◽

Thematic Analysis ◽

Secondary Care ◽

Primary Headache ◽

Primary Headaches ◽

Structured Interviews ◽

Treatment Regimens ◽

The North ◽

Qualitative Interview Study ◽

Headache Diagnosis

BackgroundCluster headache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain, ipsilateral cranial autonomic features, and a tendency to circadian and circannual periodicity.AimTo explore the perceptions, experiences, and understandings of cluster headache among GPs and neurologists.Design and settingQualitative interview study in primary care surgeries and neurology departments in the north of England.MethodSemi-structured interviews were conducted with GPs and neurologists, recorded, and transcribed. A thematic analysis was applied to the dataset.ResultsSixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the cluster headache diagnosis; impact of cluster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians recognised the delays in the diagnosis of cluster headache, misdiagnosis, and mismanagement, and were aware of the potential impact cluster headache can have on patients’ mental health and ability to remain in employment. Findings highlighted tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens. Patients’ anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals.ConclusionClinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of cluster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs.

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