Friedman Benjamin W, Hochberg Michael L, Esses David, Grosberg Brian M, Rothberg Daniel, Bernstein Benjamin, Bijur Polly E, Lipton Richard B, Gallagher E John
Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Ann Emerg Med. 2008 Dec;52(6):696-704. doi: 10.1016/j.annemergmed.2008.01.334. Epub 2008 Apr 3.
We determine the frequency of moderate or severe headache during the first 24 hours after an emergency department (ED) visit for a primary headache disorder (such as migraine or tension-type headache), determine the burden of headache during the 3 months after the ED visit, and identify predictors of poor pain and functional outcomes after ED discharge for each of these periods.
In this prospective cohort study, we enrolled headache patients during their initial ED visit, interviewed them by using a standardized questionnaire, and followed them by telephone 24 hours and 3 months after ED discharge. Two emergency physicians classified all headaches according to criteria established by the International Headache Society, using a valid questionnaire and a reproducible technique.
During an 18-month period, we enrolled 309 primary headache disorder patients in the cohort. The most common primary headache diagnoses assigned to patients were migraine, tension-type headache, and unclassifiable recurrent headache disorder. We successfully obtained follow-up in 94% of patients 24 hours after ED discharge and in 94% 3 months after ED discharge. Moderate or severe headache was present within 24 hours of ED discharge in 31% (95% confidence interval [CI] 25% to 38%) of migraine patients, 19% (95% CI 9% to 36%) of tension-type headache patients, and 27% (95% CI 18% to 38%) of the unclassifiable headache patients. Multiple functionally impairing headaches occurred during the 3 months after ED discharge in 37% of migraine patients (95% CI 30% to 44%), 38% of tension-type headache patients (95% CI 23% to 54%), and 26% of the unclassifiable headache patients (95% CI 17% to 37). After multivariate adjustment, independent predictors of poor 24-hour outcomes were severe baseline pain, baseline nausea, screening positive for depression, and longer duration of headache; the independent predictor of poor 3-month outcomes was Medicaid insurance.
Regardless of type of primary headache disorder, ED headache patients frequently experience pain and functional impairment during the hours and months after discharge.
我们确定因原发性头痛疾病（如偏头痛或紧张型头痛）到急诊科就诊后24小时内中度或重度头痛的发生率，确定急诊科就诊后3个月内头痛的负担，并确定这些时间段内急诊科出院后疼痛和功能预后不良的预测因素。
在这项前瞻性队列研究中，我们在头痛患者首次到急诊科就诊时将其纳入研究，使用标准化问卷对他们进行访谈，并在急诊科出院后24小时和3个月通过电话对他们进行随访。两名急诊科医生根据国际头痛协会制定的标准，使用有效的问卷和可重复的技术对所有头痛进行分类。
在18个月的时间里，我们在队列中纳入了309例原发性头痛疾病患者。分配给患者的最常见原发性头痛诊断为偏头痛、紧张型头痛和无法分类的复发性头痛疾病。我们在急诊科出院后24小时成功随访了94%的患者，在急诊科出院后3个月成功随访了94%的患者。31%（95%置信区间[CI]25%至38%）的偏头痛患者、19%（95%CI9%至36%）的紧张型头痛患者和27%（95%CI18%至38%）的无法分类头痛患者在急诊科出院后24小时内出现中度或重度头痛。37%的偏头痛患者（95%CI30%至44%）、38%的紧张型头痛患者（95%CI23%至54%）和26%的无法分类头痛患者（95%CI17%至37%）在急诊科出院后3个月内出现多次功能障碍性头痛。多变量调整后，24小时预后不良的独立预测因素为严重的基线疼痛、基线恶心、抑郁筛查阳性和头痛持续时间较长；3个月预后不良的独立预测因素为医疗补助保险。
无论原发性头痛疾病的类型如何，急诊科头痛患者在出院后的数小时和数月内经常经历疼痛和功能障碍。
