Abstract
Headache is a frequent symptom representing up to 9 percent of the consultations at emergency deparments; primary headaches are the leading cause of consultation (25-55 percent); migraine (36-45 percent), tension-type headache (7-35 percent). The diagnosis and management of headaches are based on a proper interrogatory, The current classification from the IHS groups headaches into primary and secondary. Paraclinical examinations are not routinely required in individuals without neurological abnormalities and without changes in the profile of pain. Their need is based in a definitive diagnosis. Diagnostic tests by neuroimaging have a poor performance in primary headaches (less than two percent). The presence of the signs called red flags suggest the existence of an underlying disorder (RR 3-11; 38-42 percent). Despite the large number of treatment possibilities, 59 percent of patients receive inadequate diagnosis, and the rates of pharmacological effectiveness are low (complete improvement within two hours 28 percent, 36 percent within 12 hours, and 37 percent within 24 hours) requiring more efficient treatments.
This is a review of headaches in the emergency services, which takes into account aspects such as the classification, the epidemiology, the utility and diagnostic performance of the paraclinical methods, and the acute treatment of headaches, especially migraine.
References
- Attia J, Hatala R, Cook D, wong J G. Does this adult patient have acute meningitis?. JAMA 1999; 282: 175-181.
- Bartsch T, Goadsby PJ. Increased responses in trigemino-cervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain 2003; 126:1801-1813.
- Bartsch T, Goadsby PJ. The Trigeminal complex and Migraine: Current concepts and synthesis. Curr Pain Headache Rep 2003; 2: 149-154.
- Bestué M, Gracia-Naya M, Santolaria L. Motivos de solicitud de neuroimagen en las cefaleas primarias. Rev Neurol 2001; 32: 127-130.
- Bigal ME, Birdini CA, Speciali JG. Etiology and ditribution of headache in two Brazilian primary care units. Headache 2000; 40: 241-247.
- Bigal ME, Bordini CA, Speciali JG. Intravenous metamizol (Dipyrone) in acute migraine treatment and in episodic tension-type headache-a placebo-controlled study. Cephalalgia 2001; 21: 90-95.
- Bigal ME, Bordini CA, Tepper SJ, Speciali JG. Intravenous magnesium in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study. Cephalalgia 2002; 22: 345-353.
- Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Chronic migraine is an earlier stage of transformed migraine in adults. Neurology 2005; 65: 1556-1561.
- Blumenthal HJ, Weisz MA, Kelly KM, Mayer RL, Blonsky J. Treatment of primary headache in the emergency department. Headache 2003; 43: 1026-1031.
- Burstein R, Jakubowski M. Implications of multimechanism therapy: when to treat? Neurology 2005; 64 (Suppl 2): S16-S20.
- Cady RK, Schreiber CP. Sinus headache or migraine?: Considerations in making a differential diagnosis. Neurology 2002; 58 (Suppl 6): S10-S14.
- Cete Y, Dora B, Ertan C, Ozdemir C, Oktay C. A randomized prospective placebo-controlled study of intravenous magnesium sulphate vs. metoclopramide in the management of acute migraine attacks in the emergency department. Cephalalgia 2004; 25: 199-204.
- Chan BTB, Ovens HJ. Chronic migraineurs: An important subgroup of patients who visit emergency departments frequently. Ann Emerg Medicine 2004; 43: 238-242.
- Colman I, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials. BMJ 2004; 329: 1369-1373.
- Cortelli P, Cevoli S, Nonino F, et al. Evidence-based diagnosis of nontraumatic headache in the emergency department: A consensus statement on four clinical scenarios. Headache 2004; 44: 587-595.
- Day JW, Raskin NH. Thunderclap Headache: Symptom of unruptured Cerebral aneurysm. Lancet 1986; 2: 1247-1248.
- Demirkaya S, Vural O, Dora B, Topçuo?lu. Efficacy of Intravenous Magnesium in the treatment of acute migraine attacks. Headache 2001; 41: 171-177.
- Diamond ML. The role of concomitant headache types and non-headache co-morbidities in the underdiagnosis of migraine. Neurology 2002; 58 (Suppl 6): S3-S9.
- Dodick D. Thunderclap Headache. Headache 2002; 42: 309-315.
- Edwards KR, Norton J, Behnke M. Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache. Headache 2001; 41: 976-980.
- Evans R W. Diagnostic testing for Headache. Med Clin North Am. 2001; 85: 865-885.
- Evidence-Based Guidelines in the Primary Care Setting: Neuroimaging in patients with Nonacute Headache. Frishberg B, Rosenberg JH, Matchar DB, McCrory DC, Pietrzak MP, Rozen TD, Silberstein SD. American Academy of Neurology Guidelines. 2000: 1-25.
- Evidence-Based Guidelines in the Primary Care Setting: Pharmacological management of acute attacks. Matchar DB, Young WB, Rosenberg JH, et al. American Academy of Neurology Guidelines. 2000: 1-58.
- Foley KA, Cady R, Martin V, et al. Treating early versus treating mild: Timing of migraine prescription medications among patients with diagnosed migraine. Headache 2005; 45: 538-545.
- Forsyth PA, Posner JB. Headache in patients with Brain Tumors. A study of 111 patients. Neurology 1993; 43: 1678-1683.
- Freitag FG, Kozma CM, Slaton T, Osterhaus JT, Barron R. Characterization and prediction of emergency department use in chronic daily headache patients. Headache 2005; 891-898.
- Friedman BW, Corbo J, Lipton RB, et al. A trial of metoclopramide vs. sumatriptán for the emergency department treatment of migraines. Neurology 2005; 64: 463-468.
- Gopal A K, Whitehouse J D. Cranial computed tomography before lumbar puncture: A prospective evaluation. Arch Intern Med 1999; 159: 2681-2685.
- Grosskreutz SR, Osborn RE, Sanchez RM. Computed tomography of the brain in the evaluation of the headache patient. Mil Med 1991; 156: 137-140.
- Halpern MT, Lipton RB, Cady RK, Kwong WJ, Marlo KO, Batenhorst AS. Costs and outcomes of early versus delayed migraine treatment with sumatriptán. Headache 2002; 42: 984-999.
- Hasbun R, Abrahams J, Jekel J, Quagliarello V. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. NEJM 2001; 345: 1727-1733.
- Jiménez-Caballero PE. Análisis de las cefaleas atendidas en las guardias de neurología. Rev Neurol 2005; 40: 648-651.
- Kaniecki RG. Migraine and tension-type headache: An assesment of challenges in diagnosis. Neurology 2002; 58 (Suppl 6): S15-S20.
- Kaplan S L. Clinical presentation, diagnosis and prognostic factors of bacterial meningitis. Infec Dis Clin North Am 1999; 13: 579-594.
- Kelly AM. Migraine: Pharmacotherapy in the emergency deparment. J Accid Emerg Med 2000; 173: 241-245.
- Komolafe MA, Komolafe EO, Olugbodi AA, Adeolu AA. Which headache do we need to investigate? Cephalalgia 2006; 26: 87-88.
- Krusz JC, Scott V, Belanger J. Intravenous Propofol: Unique effectiveness in treating intractable migraine. Headache 2000; 40:224-230.
- Lane PL, Nituica CM, Sorondo B. Headache patients: Who does not come to the emergency department? Acad Emerg Med 2003; 10: 528.
- Leniger T, Pageler L, Stude P, Diener HC, Limmroth V.Comparison of intravenous valproate with intravenous lysine-acetylsalicylic acid in acute migraine attacks. Headache 2005; 45: 42-46.
- Levin M. Chronic daily headache and the revised International Headache Society Classification. Curr Pain Headache Rep 2004; 8: 59-65.
- Lipton RB, Cady RK, Stewart WF, et al. Diagnostic lessons from the spetrum study. Neurology 2002; 58 (Suppl 6): S27-S31.
- Lipton RB, Diamond S, Reed M, Diamond ML, Stewart WF. Migraine diagnosis and Treatment: Results from the American Migraine Study II. Headache 2001; 41: 638-645.
- Lipton RB, Hamelsky SW, Dayno JM. What do patients with migraine want from acute migraine treatment ? Headache 2002; 42 (Suppl 1): S3-S9.
- Lipton RB, Silberstein SD, Saper JR, Bigal ME, Goadsby PJ. Why headache treatment fails. Neurology 2003; 60: 1064-1070.
- Lipton RB, Stewart WF, Celentano DD, Reed ML. Undiagnosed Migraine Headaches: A comparison of symptom-based and reported physician diagnosis. Arch Intern Med 1992; 152: 1273-1278.
- Maizels M, Scott B, Cohen W, Chen W. Intranasal lidocaine for treatment of migraine: a randomized, double- blind, controlled trial. JAMA 1996; 276: 319-321.
- Maizels M. Health resource utilization of the emergency department headache “repeater”. Headache 2002; 42: 747-753.
- Mathew NT, Kailasam J, Seifert T. Clinical recognition of allodynia in migraine. Neurology 2004; 63: 848-852.
- Mathew NT. Dosing and administration of Ergotamine tartrate and Dihydroergotamine. Headache 1997; 37 (Suppl 1): S26-S32.
- Mitchell CS, Osborn RE, Grosskreutz SR. Computed tomography in the headache patient: is routine evaluation really necessary? Headache 1993; 33: 82-86.
- Monzillo PH, Nemoto PH, Costa AR, Snavito WL. Tratamento agudo da crise de enxaqueca refrataria na emergencia. Estudo comparativo entre dexametasoa e haloperidol. Arq Neurosiquiatr 2004; 62: 513-518.
- Pascual J. Clinical Benefits of Early Triptan Therapy for Migraine. Headache 2002; 42 (Suppl 1): 10-17.
- Peroutka SJ. Dopamine and migraine. Neurology 1997; 49: 650-656.
- Piovesan EJ, Kowacs PA, Oshinky ML. Convergence of Cervical and trigeminal sensory afferents. Curr Pain Headache Rep 2003; 2: 155-161.
- Purdy R A. Clinical Evaluation of a patient presenting with Headache. Med Clin North Am 2001; 85: 847-863.
- Purdy RA. When to do what: Neurologic testing in headache. Semin Headache Manag. 1999; 4: 1-15.
- Report of the Quality Standards Subcommittee of the American Academy of Neurology Practice Guidelines. The Utility of neuroimaging in the evaluation of headache in patients with normal neurological examination. Neurology 1994; 44: 1353-1354.
- Rueda-Sánchez M, Mantilla-McCormick FJ, Solano MN, Ortiz CJ. Prevalencia de cefaleas en un servicio de urgencias en Colombia. Rev Neurol 2005; 40: 209-213.
- Schvienk W I. Intracraneal Aneurisms. NEJM. 1997; 336: 28-40.
- Sempere AP, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia 2004; 25: 30-35.
- Silberstein SD, Goadsby PJ, Lipton RB. Management of Migraine: An Algorithmic approach. Neurology 2000; 55 (Suppl 2): S46-S52.
- Silberstein SD, Lipton RB, Solomon S, Mathew NT. Classification of daily and near daily headaches: Proposed revisions to the IHS criteria. Headache 1994; 34: 1-7.
- Siow HC, Young WB, Silberstein SD. Neuroleptics in headache. Headache 2005; 45: 358-371.
- Smetana. The diagnostic value of historical features in primary headache syndromes. Arch Intern Med 2000; 160: 2729-2737.
- Stillman MJ, Zajac D, Rybicki LA. Treatment of primary headache disorders with intravenous valproate: Initial outpatient experience. Headache 2004; 44: 65-69.
- The International Classification of Headache Disorders. Headache Subcommittee of the International Headache Society. Cephalalgia 2004; 24 (Suppl 1): 1-150.
- Volcy Gómez M. Cefalea Crónica Diaria: Diagnóstico y Fisiopatología. Rev Neurol 2005; 40: 116-121.
- Volcy Gómez M. Cefalea crónica diaria: Tratamiento.
Rev Neurol 2005; 40: 180-187.
- Ward T N, Levin M, Phillips J M. Evaluation and Management of Headache in the Emergency Room. Med Clin North Am. 2001; 85: 971-986.
- Wasiak J, Anderson JN. Is dexamethasone effective in treating acute migraine headache? Med J Aust 2002; 176: 83.
- Williams DR, Stark RJ. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia 2003; 963-971.
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