ORIGINAL ARTICLE

Headache management—Are we doing enough? An observational study of patients presenting with headache to the emergency department

T Locker¹, S Mason¹, A Rigby²

¹ Accident and Emergency Department, Northern General Hospital, Sheffield, UK
² Department of General Practice and Primary Care, University of Sheffield, UK

Correspondence to:
Correspondence to:
Mr T Locker
Accident and Emergency Department, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK; t.locker{at}sheffield.ac.uk

Objectives: To identify the causes of acute headache presenting to the emergency department (ED), assess the adequacy of history, examination, and investigation, and determine which clinical features are predictive of secondary headache.

Method: A retrospective study of alert (GCS14) patients presenting with headache, to an ED over a one year period. Patients were followed up for three months. The adequacy of history, examination, and investigation were compared with published standards. Analysis using Bayes’s theorem determined which clinical features were predictive of secondary headache.

Results: Headache in alert patients accounted for 0.5% (n = 353) of new patient episodes, 81.2% (n = 280) of patients had a primary headache disorder. One patient (0.3%) had an adequate history recorded. No patient had a complete examination recorded. Seventy seven (21.8%) patients underwent computed tomography of the head; 80.5% (n = 62) were normal. Lumbar puncture was performed in 23 (6.5%) cases; 18 (78.3%) were normal. A number of clinical features were found to be predictive of secondary headache.

Conclusion: Headache is an uncommon symptom in alert patients presenting to the ED. The recorded history, examination, and subsequent investigation do not comply with published standards. A number of predictive features have been identified that may permit the development of a clinical prediction rule to improve the management of this patient group.

Keywords: headache

Abbreviations: SAH, subarachnoid haemorrhage; ED, emergency department

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Breen, D.P., Duncan, C.W., Pope, A.E., Gray, A.J., Al-Shahi Salman, R. (2008). Emergency department evaluation of sudden, severe headache. QJM 101: 435-443 [Abstract] [Full Text]  
• Detsky, M. E., McDonald, D. R., Baerlocher, M. O., Tomlinson, G. A., McCrory, D. C., Booth, C. M. (2006). Does this patient with headache have a migraine or need neuroimaging?. JAMA 296: 1274-1283 [Abstract] [Full Text]  
• Gahir, K K, Larner, A J (2006). Primary headache disorder in the emergency department: perspective from a general neurology outpatient clinic. Emerg. Med. J. 23: 135-136 [Abstract] [Full Text]  

eLetters:

Read all eLetters

Primary Headache Disorder in the Emergency Department

Andrew J Larner, et al.

EMJ Online, 10 Aug 2004 [Full text]

RULES FOR HEADACHE IN AN ED

CELIO LEVYMAN,MD,MSc

EMJ Online, 6 Sep 2004 [Full text]