Neurology Department, Universidad del Rosario-Hospital MEDERI, Bogotá, Colombia.
Neurology Department, Fundación Universitaria Sanitas-Clínica Universitaria Colombia, Bogotá, Colombia.
PLoS One. 2019 Jan 7;14(1):e0208728. doi: 10.1371/journal.pone.0208728. eCollection 2019.
Non-traumatic headaches account for 0.5 to 4.5% at the emergency department (ED). Although primary headaches represent the most common causes, the likelihood of ominous etiology has to be considered by clinicians in order to avoid diagnostic and therapeutic pitfalls. Due to the absence of biological or imaging findings to diagnose primary headaches we hypothesize ICHD 3(International Headache criteria 3) criteria as a useful tool at the moment to identify and to establish a difference between those patients who are undergoing primary headaches and those who will need advanced diagnostic strategies.
To determine the usefulness of ICHD 3 criteria to differentiate primary from non-primary headaches at the emergency department (ED).
During five weeks all the patients complaining of headache attended at the triage unit at the ED were interviewed, examined and classified as having primary or non-primary headaches by means of ICHD 3 criteria. Those patients with primary headaches were treated according to standard of care protocols and followed up by means of phone call communication after 48 hours to assure satisfactory outcome. Those patients classified as having non-primary headaches (secondary headaches and neuralgias) were admitted for additional diagnostic and therapeutic interventions. Between both groups we compared the prevalence of fulfilled criteria for primary headaches and the proportion of traditional red flags such as age, sleep headache onset, associated symptoms, abnormal neurological exam, sudden onset, and nonresponse to analgesics in addition to previous consultation before this evaluation.
Headache was responsible for 244 (2.3%) out of 10450 admissions at the ED, 77.8% were females. Primary, non-primary (secondary plus neuralgias) and unclassified headaches were 59.4%, 32% and 8.6% respectively. Migraine and cervical myofascial pain were the most frequent etiologies for primary and non-primary causes respectively. Factors associated to non-primary etiologies were immunosuppression (OR: 2.7 IC 95% 2.3-3.3) and age older than 50 (OR: 2.7 IC 95% 2.01-3.62). Abnormal neurological exam, sudden and sleep headache onset were not statistically significant. Factors found to be associated with primary headaches were: fulfilling ICHD 3 criteria (OR: 18.7, IC95% 7.1-48.6), history of migraine (OR: 2.9 IC 95% 2.1-3.9), and history of similar episodes (OR: 2.7 IC 95% 2.3-3.3).
This data suggests that fulfilling ICHD 3 criteria could be useful to differentiate primary from non-primary headaches. This observation is also valid for immunosuppression, age older than 50, history of migraine and history of similar episodes.
在急诊科（ED），非创伤性头痛占 0.5%至 4.5%。虽然原发性头痛是最常见的原因，但临床医生有必要考虑到不祥病因的可能性，以避免诊断和治疗上的陷阱。由于没有生物学或影像学发现来诊断原发性头痛，我们假设 ICHD 3（国际头痛标准 3）标准是目前识别和区分正在经历原发性头痛和需要更先进诊断策略的患者的有用工具。
确定 ICHD 3 标准在急诊科（ED）区分原发性和非原发性头痛的有用性。
在五周的时间里，对在 ED 分诊单元就诊的所有头痛患者进行了访谈、检查，并根据 ICHD 3 标准分类为原发性或非原发性头痛。根据标准护理方案对原发性头痛患者进行治疗，并在 48 小时后通过电话随访以确保满意的结果。将被分类为非原发性头痛（继发性头痛和神经痛）的患者收治入院进行进一步的诊断和治疗干预。在这两组患者中，我们比较了满足原发性头痛标准的患病率，以及传统危险信号（如年龄、睡眠头痛发作、伴随症状、异常神经检查、突然发作、以及在此评估之前的先前咨询）的比例。
头痛导致 10450 名 ED 住院患者中的 244 人（2.3%），其中 77.8%为女性。原发性、非原发性（继发性加神经痛）和未分类头痛分别占 59.4%、32%和 8.6%。偏头痛和颈肌筋膜痛分别是原发性和非原发性病因的最常见病因。与非原发性病因相关的因素包括免疫抑制（OR：2.7，95%CI 2.3-3.3）和年龄大于 50 岁（OR：2.7，95%CI 2.01-3.62）。异常神经检查、突然发作和睡眠性头痛发作没有统计学意义。与原发性头痛相关的因素包括：符合 ICHD 3 标准（OR：18.7，95%CI 7.1-48.6）、偏头痛病史（OR：2.9，95%CI 2.1-3.9）和类似发作史（OR：2.7，95%CI 2.3-3.3）。
这些数据表明，符合 ICHD 3 标准可有助于区分原发性和非原发性头痛。这种观察结果对于免疫抑制、年龄大于 50 岁、偏头痛病史和类似发作史也是有效的。
