Observational Study

. 2021 Nov;61(10):1539-1552.

doi: 10.1111/head.14230. Epub 2021 Nov 2.

Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)-A multinational observational study

Anne Maree Kelly^{1

2}, Win Sen Kuan^{3

4}, Kevin H Chu^{5

6}, Frances B Kinnear^{7

8}, Gerben Keijzers^{9

10

11}, Mehmet A Karamercan¹², Sharon Klim^{1

2

13}, Tissa Wijeratne^{14

15}, Sinan Kamona^{16

17}, Colin A Graham¹⁸, Richard Body^{19

20}, Tom Roberts^{21

22}, Daniel Horner^{23

24}, Said Laribi²⁵; and the HEAD Study Group

Collaborators, Affiliations

Collaborators

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

PMID: 34726783
DOI: 10.1111/head.14230

Observational Study

Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)-A multinational observational study

Anne Maree Kelly et al. Headache. 2021 Nov.

. 2021 Nov;61(10):1539-1552.

doi: 10.1111/head.14230. Epub 2021 Nov 2.

Authors

Collaborators

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

PMID: 34726783
DOI: 10.1111/head.14230

Abstract

Objective: To describe the epidemiology of nontraumatic headache in adults presenting to emergency departments (EDs).

Background: Headache is a common reason for presentation to EDs. Little is known about the epidemiology, investigation, and treatment of nontraumatic headache in patients attending EDs internationally.

Methods: An international, multicenter, observational, cross-sectional study was conducted over one calendar month in 2019. Participants were adults (≥18 years) with nontraumatic headache as the main presenting complaint. Exclusion criteria were recent head trauma, missing records, interhospital transfers, re-presentation with same headache as a recent visit, and headache as an associated symptom. Data collected included demographics, clinical assessment, investigation, treatment, and outcome.

Results: We enrolled 4536 patients (67 hospitals, 10 countries). "Thunderclap" onset was noted in 14.2% of cases (644/4536). Headache was rated as severe in 27.2% (1235/4536). New neurological examination findings were uncommon (3.2%; 147/4536). Head computed tomography (CT) was performed in 36.6% of patients (1661/4536), of which 9.9% showed clinically important pathology (165/1661). There was substantial variation in CT scan utilization between countries (15.9%-75.0%). More than 30 different diagnoses were made. Presumed nonmigraine benign headache accounted for 45.4% of cases (2058/4536) with another 24.3% classified as migraine (1101/4536). A small subgroup of patients have a serious secondary cause for their headache (7.1%; 323/4536) with subarachnoid hemorrhage (SAH), stroke, neoplasm, non-SAH intracranial hemorrhage/hematoma, and meningitis accounting for about 1% each. Most patients were treated with simple analgesics (paracetamol, aspirin, or nonsteroidal anti-inflammatory agents). Most patients were discharged home (83.8%; 3792/4526). In-hospital mortality was 0.3% (11/4526).

Conclusion: Diagnosis and management of headache in the ED is challenging. A small group of patients have a serious secondary cause for their symptoms. There is wide variation in the use of neuroimaging and treatments. Further work is needed to understand the variation in practice and to better inform international guidelines regarding emergent neuroimaging and treatment.

Keywords: emergency department; headache; imaging.

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Comment in

Direct ophthalmoscopy in the evaluation of emergency department patients with headache: Time to rethink?
Kelly AM. Kelly AM. Emerg Med Australas. 2023 Apr;35(2):357-358. doi: 10.1111/1742-6723.14176. Epub 2023 Jan 11. Emerg Med Australas. 2023. PMID: 36628956 No abstract available.

References

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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;24:53-62.
1. National Center for Health Statistics. Ambulatory Health Care Data. 2017. Accessed December 11, 2020. https://www.cdc.gov/nchs/ahcd/new_ahcd.htm
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1. Goldstein JN, Camargo CA, Pelletier AJ, Edlow JA. Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia. 2006;26:684-690. Accessed May 2021. https://ichd-3.org/

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Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)-A multinational observational study

Collaborators

Affiliations

Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)-A multinational observational study

Authors

Collaborators

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical