Clinical presentation and assessment of older patients presenting with headache to emergency departments: A multicentre observational study

Sierra Beck^{1

2}, Frances B Kinnear^{3

4}, Anne Maree Kelly^{5

6}, Kevin H Chu^{7

8}, Win Sen Kuan^{9

10}, Gerben Keijzers^{11

12

13}, Richard Body^{14

15}, Mehmet A Karamercan¹⁶, Sharon Klim⁵, Tissa Wijeratne^{17

18

19}, Sinan Kamona^{20

21}, Colin A Graham²², Tom Roberts²³, Daniel Horner^{24

25}, Said Laribi^{26

27}; HEAD Study Group

Collaborators, Affiliations

Collaborators

HEAD Study Group:
Catherine Lunter, Rochelle Facer, David Thomson, Robert Day, Greg McDonald, Sarah Jones, Julian Cochrane, Stephen Gourley, Mark Ross, Vinay Gangathimmaiah, Kim Hansen, Frances B Kinnear, Gerben Keijzers, Kevin Chu, Paul Bowe, Raymund de la Cruz, Daniel Haustead, Jean Moller, Katie Walker, Richard D Smith, Ron Sultana, John Pasco, Neil Goldie, Andis Graudins, Rosamond Dwyer, George Plunkett, Anne-Maree Kelly, Hugh Mitenko, Michael Lovegrove, Ben Smedley, Colin A Graham, Ling Yan Leung, Win Sen Kuan, Ying Wei Yau, Wei Ming Ng, Ranjeev Kumar, Dennis Wen Jie Chia, Said Laribi, Mounir Hilal, Rarthtana Mil, Audrey Gerineau, Matthew J Reed, Daniel Horner, Edward Carlton, Tom Roberts, Girish Boggaram, Jayne Foot, Andy Appleboam, Rachel Goss, Hamza Malik, Richard Body, John-Paul Williamson, Adela Golea, Sonia Luka, Huseyin Avni Demir, Şafak Öner Gülpinar, Lale Tolu, Muhammet Hacimustafaoğlu, Mehmet A Karamercan, Elif Çelikel, Çilem Çaltili, Selahattin Gürü, Gülşah Yavuz, Franck Verschuren, Christopher Ramos, Paule Denoel, Nicolas Wilmet, Michael Vandoorslaert, Alessandro Manara, Adeline Higuet, Amichai Sheffy, Sinan Kamona, Peter Jones, Mai Nguyen, Anne Clarke, Sierra Beck, Andrew Munro, Kim M Yates, James Weaver, Deborah Moore, Stuart Innes, Karina Walters, Koen Simons, Anne-Maree Kelly, Kevin Chu, Tissa Wijeratne, Frances B Kinnear, Gerben Keijzers, Sinan Kamona, Win Sen Kuan, Colin Graham, Richard Body, Said Laribi, Sharon Klim, Mehmet Karamercan, Tom Roberts, Anne-Maree Kelly, Sharon Klim, Kerrie Russell

Affiliations

¹ Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
² Emergency Department, Dunedin Hospital, Dunedin, New Zealand.
³ Emergency & Children's Services, The Prince Charles Hospital, Chermside, Qld, Australia.
⁴ Department of Medicine, University of Queensland, St Lucia, Qld, Australia.
⁵ Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Melbourne, Vic., Australia.
⁶ Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Vic., Australia.
⁷ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
⁸ Faculty of Medicine, University of Queensland, St Lucia, Qld, Australia.
⁹ Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
¹⁰ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹¹ Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Qld, Australia.
¹² Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia.
¹³ School of Medicine, Griffith University, Gold Coast, Qld, Australia.
¹⁴ Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
¹⁵ Emergency Department, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.
¹⁶ Faculty of Medicine Department of Emergency Medicine, Gazi University, Ankara, Turkey.
¹⁷ The University of Melbourne, Parkville, Australia.
¹⁸ Department of Neurology, Western Health, St Albans, Vic., Australia.
¹⁹ Public Health School, La Trobe University, Bundoora, Vic., Australia.
²⁰ School of Medicine, University of Auckland, Auckland, New Zealand.
²¹ Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand.
²² Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR.
²³ Trainee Emergency Research Network (TERN), North Bristol NHS Trust, Bristol, UK.
²⁴ Emergency Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.
²⁵ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Oxford, UK.
²⁶ Emergency Medicine Department, Tours University Hospital, Tours, France.
²⁷ EUSEM Research Network, Aartselaar, Belgium.

PMID: 34570422
DOI: 10.1111/ajag.12999

Observational Study

Clinical presentation and assessment of older patients presenting with headache to emergency departments: A multicentre observational study

Sierra Beck et al. Australas J Ageing. 2022 Mar.

. 2022 Mar;41(1):126-137.

doi: 10.1111/ajag.12999. Epub 2021 Sep 27.

Authors

Collaborators

HEAD Study Group:
Catherine Lunter, Rochelle Facer, David Thomson, Robert Day, Greg McDonald, Sarah Jones, Julian Cochrane, Stephen Gourley, Mark Ross, Vinay Gangathimmaiah, Kim Hansen, Frances B Kinnear, Gerben Keijzers, Kevin Chu, Paul Bowe, Raymund de la Cruz, Daniel Haustead, Jean Moller, Katie Walker, Richard D Smith, Ron Sultana, John Pasco, Neil Goldie, Andis Graudins, Rosamond Dwyer, George Plunkett, Anne-Maree Kelly, Hugh Mitenko, Michael Lovegrove, Ben Smedley, Colin A Graham, Ling Yan Leung, Win Sen Kuan, Ying Wei Yau, Wei Ming Ng, Ranjeev Kumar, Dennis Wen Jie Chia, Said Laribi, Mounir Hilal, Rarthtana Mil, Audrey Gerineau, Matthew J Reed, Daniel Horner, Edward Carlton, Tom Roberts, Girish Boggaram, Jayne Foot, Andy Appleboam, Rachel Goss, Hamza Malik, Richard Body, John-Paul Williamson, Adela Golea, Sonia Luka, Huseyin Avni Demir, Şafak Öner Gülpinar, Lale Tolu, Muhammet Hacimustafaoğlu, Mehmet A Karamercan, Elif Çelikel, Çilem Çaltili, Selahattin Gürü, Gülşah Yavuz, Franck Verschuren, Christopher Ramos, Paule Denoel, Nicolas Wilmet, Michael Vandoorslaert, Alessandro Manara, Adeline Higuet, Amichai Sheffy, Sinan Kamona, Peter Jones, Mai Nguyen, Anne Clarke, Sierra Beck, Andrew Munro, Kim M Yates, James Weaver, Deborah Moore, Stuart Innes, Karina Walters, Koen Simons, Anne-Maree Kelly, Kevin Chu, Tissa Wijeratne, Frances B Kinnear, Gerben Keijzers, Sinan Kamona, Win Sen Kuan, Colin Graham, Richard Body, Said Laribi, Sharon Klim, Mehmet Karamercan, Tom Roberts, Anne-Maree Kelly, Sharon Klim, Kerrie Russell

Affiliations

¹ Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
² Emergency Department, Dunedin Hospital, Dunedin, New Zealand.
³ Emergency & Children's Services, The Prince Charles Hospital, Chermside, Qld, Australia.
⁴ Department of Medicine, University of Queensland, St Lucia, Qld, Australia.
⁵ Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Melbourne, Vic., Australia.
⁶ Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Vic., Australia.
⁷ Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
⁸ Faculty of Medicine, University of Queensland, St Lucia, Qld, Australia.
⁹ Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
¹⁰ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹¹ Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Qld, Australia.
¹² Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia.
¹³ School of Medicine, Griffith University, Gold Coast, Qld, Australia.
¹⁴ Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
¹⁵ Emergency Department, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.
¹⁶ Faculty of Medicine Department of Emergency Medicine, Gazi University, Ankara, Turkey.
¹⁷ The University of Melbourne, Parkville, Australia.
¹⁸ Department of Neurology, Western Health, St Albans, Vic., Australia.
¹⁹ Public Health School, La Trobe University, Bundoora, Vic., Australia.
²⁰ School of Medicine, University of Auckland, Auckland, New Zealand.
²¹ Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand.
²² Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR.
²³ Trainee Emergency Research Network (TERN), North Bristol NHS Trust, Bristol, UK.
²⁴ Emergency Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.
²⁵ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Oxford, UK.
²⁶ Emergency Medicine Department, Tours University Hospital, Tours, France.
²⁷ EUSEM Research Network, Aartselaar, Belgium.

PMID: 34570422
DOI: 10.1111/ajag.12999

Abstract

Objective: To describe the characteristics, assessment and management of older emergency department (ED) patients with non-traumatic headache.

Methods: Planned sub-study of a prospective, multicentre, international, observational study, which included adult patients presenting to ED with non-traumatic headache. Patients aged ≥75 years were compared to those aged <75 years. Outcomes of interest were epidemiology, investigations, serious headache diagnosis and outcome.

Results: A total of 298 patients (7%) in the parent study were aged ≥75 years. Older patients were less likely to report severe headache pain or subjective fever (both P < 0.001). On examination, older patients were more likely to be confused, have lower Glasgow Coma Scores and to have new neurological deficits (all P < 0.001). Serious secondary headache disorder (composite of headache due to subarachnoid haemorrhage (SAH), intracranial haemorrhage, meningitis, encephalitis, cerebral abscess, neoplasm, hydrocephalus, vascular dissection, stroke, hypertensive crisis, temporal arteritis, idiopathic intracranial hypertension or ventriculoperitoneal shunt complications) was diagnosed in 18% of older patients compared to 6% of younger patients (P < 0.001). Computed tomography brain imaging was performed in 66% of patients ≥75 years compared to 35% of younger patients (P < 0.001). Older patients were less likely to be discharged (43% vs 63%, P < 0.001).

Conclusions: Older patients with headache had different clinical features to the younger cohort and were more likely to have a serious secondary cause of headache than younger adults. There should be a low threshold for investigation in older patients attending ED with non-traumatic headache.

Keywords: aged; emergency departments; epidemiology; headache.

PubMed Disclaimer

References

REFERENCES

1. Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: Updated age, sex, and socioeconomic-specific estimates from government health surveys. Headache. 2021;61(1):60-68. doi:10.1111/head.14024
1. Chu KH, Howell TE, Keijzers G, et al. Acute headache presentations to the emergency department: a statewide cross-sectional study. Acad Emerg Med. 2017;24(1):53-62. doi:10.1111/acem.13062.3
1. Friedman BW, Serrano D, Reed M, et al. Use of the emergency department for severe headache. A population-based study. Headache. 2009;49(1):21-30. doi:10.1111/j.1526-4610.2008.01282.x
1. Solomon GD, Kunkel RS Jr, Frame J. Demographics of headache in elderly patients. Headache. 1990;30(5):273-276. doi:10.1111/j.1526-4610.1990.hed3005273.x
1. Ruiz M, Pedraza MI, de la Cruz C, et al. Headache in the elderly: characteristics in a series of 262 patients. Neurologia. 2014;29(6):321-326. doi:10.1016/j.nrl.2013.07.007

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Clinical presentation and assessment of older patients presenting with headache to emergency departments: A multicentre observational study

Collaborators

Affiliations

Clinical presentation and assessment of older patients presenting with headache to emergency departments: A multicentre observational study

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical