Blumenthal Harvey J, Weisz Michael A, Kelly Karen M, Mayer Renae L, Blonsky Jeffrey
Neurological Associates of Tulsa, Inc, Tulsa, OK 74136, USA.
Headache. 2003 Nov-Dec;43(10):1026-31. doi: 10.1046/j.1526-4610.2003.03202.x.
Each year many patients present to an emergency department for treatment of acute primary headache. We investigated the diagnosis and clinical outcome of patients treated for primary headache in the emergency department.
Patients treated for acute primary headache in the emergency department completed a questionnaire related to their headache symptoms, response to treatment, and ability to return to normal function. These responses were compared to the treating physicians' observations of the patient's condition at the time of discharge from the emergency department.
Based on the questionnaire, 95% of the 57 respondents met International Headache Society diagnostic criteria for migraine. Emergency department physicians, however, diagnosed only 32% of the respondents with migraine, while 59% were diagnosed as having "cephalgia" or "headache NOS" (not otherwise specified). All patients previously had taken nonprescription medication, and 49% had never taken a triptan. In the emergency department, only 7% of the patients received a drug "specific" for migraine (ie, a triptan or dihydroergotamine). Sixty-five percent of the patients were treated with a "migraine cocktail" comprised of a variable mixture of a nonsteroidal anti-inflammatory agent, a dopamine antagonist, and/or an antihistamine; 24% were treated with opioids. All 57 patients reported that after discharge they had to rest or sleep and were unable to return to normal function. Sixty percent of patients still had headache 24 hours after discharge from the emergency department.
The overwhelming majority of patients who present to an emergency department with acute primary headache have migraine, but the majority of patients receive a less specific diagnosis and a treatment that is correspondingly nonspecific.
每年都有许多患者前往急诊科治疗急性原发性头痛。我们调查了在急诊科接受原发性头痛治疗的患者的诊断情况和临床结局。
在急诊科接受急性原发性头痛治疗的患者完成了一份有关其头痛症状、治疗反应以及恢复正常功能能力的问卷。将这些回答与治疗医生在患者从急诊科出院时对其病情的观察结果进行比较。
根据问卷，57名受访者中有95%符合国际头痛协会的偏头痛诊断标准。然而，急诊科医生仅将32%的受访者诊断为偏头痛，而59%被诊断为“头痛”或“未另行特指的头痛”（NOS）。所有患者此前都服用过非处方药，49%从未服用过曲坦类药物。在急诊科，只有7%的患者接受了针对偏头痛的“特效”药物（即曲坦类药物或双氢麦角胺）。65%的患者接受了由非甾体抗炎药、多巴胺拮抗剂和/或抗组胺药组成的不同组合的“偏头痛鸡尾酒”治疗；24%的患者接受了阿片类药物治疗。所有57名患者均报告出院后必须休息或睡觉，无法恢复正常功能。60%的患者在从急诊科出院24小时后仍有头痛。
绝大多数因急性原发性头痛前往急诊科就诊的患者患有偏头痛，但大多数患者得到的诊断不够明确，相应地接受的治疗也缺乏特异性。
