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43 Management of patients with headache presenting to a neurological emergency room

Published online by Cambridge University Press:  24 June 2014

V. Vuković,
M. Knežević-Pavlić,
J. Tumpić-Jaković,
M. Strineka,
A. Lovrenčić-Huzjan and
V. Demarin
V. Vuković
Affiliation:
University Hospital “Sestre Milosrdnice”, Department of Neurology, Zagreb, Croatia
M. Knežević-Pavlić
Affiliation:
General Hospital Našice, Department of Neurology, Našice, Croatia
J. Tumpić-Jaković
Affiliation:
General Hospital Virovitica, Department of Neurology, Virovitica, Croatia
M. Strineka
Affiliation:
University Hospital “Sestre Milosrdnice”, Department of Neurology, Zagreb, Croatia
A. Lovrenčić-Huzjan
Affiliation:
University Hospital “Sestre Milosrdnice”, Department of Neurology, Zagreb, Croatia
V. Demarin
Affiliation:
University Hospital “Sestre Milosrdnice”, Department of Neurology, Zagreb, Croatia
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Abstract

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Introduction:

Patients with headache frequently seek help in a neurological emergency room. In this study we tried to analyse the management of patients presenting with a headache to the emergency room (ER) at the University Hospital “Sestre milosrdnice” in Zagreb.

Methods:

We have retrospectively analysed all patients with headache who were examined in our emergency room during 2007. Patient data were analyzed according to the diagnoses, diagnostic procedures, treatment and further refferal.

Results:

Among 6225 patients, 1385 (22.3%) complained of headache; 894 (64.9%) women and 491 (35.4%) men. Migraine with or without aura, tension-type headache or cervicogenic headache had 1009 (72.9%) of patients (67.3% women and 32.7% men); 84 (6%) had intracranial haemorrhage, 33 (2.3%) had primary tumour, 54 (3.8%) metastases, 193 (13.9%) head trauma, 7 (0.5%) head trauma with heamorrhage and 5 (0.4%) had an infective disease. A diagnostic procedure was indicated in 413 (29.8%) of patients: 314 (22.7%) had a CT scan, 85 (6.1%) an EEG and 70 (5%) had an ultrasound examination. Patient refferal was as following: 1022 (73.8%) was dismissed home, 222 (16%) was reffered to other clinics and 141 (10.2%) was hospitalized. Among patients with primary and cervicogenic headaches a diagnostic procedure was performed in 235 (23.2%) while 45 (4.5%) was hospitalized.

Conclusions:

Patients with primary headaches frequently seek help in the ER. For patients with primary headaches, better treatment should be provided by GPs and neurologists (headache specialists) in out-patient headache clinics. Mass media campaignes should be carried out in order to bring closer the possibilities oftreatment for primary headaches.