Department of Experimental and Clinical Medicine and Experimental and Clinical Neurosciences, Neurological Clinic, Headache Center, University Hospital of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
Emergency Department, University Hospital of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
Acta Neurol Belg. 2020 Feb;120(1):19-24. doi: 10.1007/s13760-020-01272-y. Epub 2020 Jan 21.
To evaluate therapies employed in patients presenting to the emergency department (ED) with a chief complaint of non-traumatic headache to check if guidelines are followed. A 6-month retrospective analysis of the ED records of all the patients who referred to the ED of the University Hospital of Trieste for non-traumatic headache was performed. Out of 37.335 admissions, 336 patients were selected (0.9%). Diagnosis at discharge was primary headache (25.6%), secondary headache (40.5%), and headache "not otherwise specified" (33.9%). One-hundred-ninety-three patients were treated in mono- (51.8%) or poly-therapy (48.2%), with NSAIDs (46.5%), benzodiazepines (13.4%), antiemetics (10.7%), analgesics (8.3%), opioids (1.6%), triptans (1.5%), and other drugs (17.7%). NSAIDs, particularly ketorolac, are the class of drugs most often prescribed in ED, independently of the discharge diagnosis. Metoclopramide is rarely used in monotherapy (4%), but it is the drug most frequently used in association with NSAIDs (19.3%). Only two migraineurs received triptans. Mean time spent in ED was 231 ± 130 min, which was significantly longer in patients who received treatment (272 ± 141 vs. 177 ± 122 min; p = 0.003). No drugs had any side effects. In accordance with the current guidelines, NSAIDs monotherapy or in association with antiemetics were the drugs most often prescribed in ED. Opioids were rarely used probably because of potential sedative side effects. Only very few patients received triptans. Special attention should be drawn also in ED to apply the International Classification of Headache Disorders criteria, which can lead to clarify the diagnosis and receive the specific treatment.
评估以非创伤性头痛为主诉就诊于急诊科的患者所接受的治疗方法，以检查是否遵循指南。
对的里雅斯特大学医院急诊科所有因非创伤性头痛就诊的患者的急诊记录进行了 6 个月的回顾性分析。在 37335 例就诊中，共选择了 336 例患者（0.9%）。出院诊断为原发性头痛（25.6%）、继发性头痛（40.5%）和“未特定的头痛”（33.9%）。193 例患者接受单药（51.8%）或多药（48.2%）治疗，使用的药物有 NSAIDs（46.5%）、苯二氮䓬类（13.4%）、止吐药（10.7%）、镇痛药（8.3%）、阿片类药物（1.6%）、曲坦类（1.5%）和其他药物（17.7%）。非甾体抗炎药（NSAIDs），尤其是酮咯酸，是急诊科最常开的药物，与出院诊断无关。甲氧氯普胺单独使用很少（4%），但与 NSAIDs 联合使用最常见（19.3%）。仅有 2 例偏头痛患者使用了曲坦类药物。急诊科的平均停留时间为 231±130 分钟，接受治疗的患者停留时间明显更长（272±141 与 177±122 分钟；p=0.003）。没有药物出现任何副作用。根据现行指南，NSAIDs 单药或与止吐药联合使用是急诊科最常开的药物。阿片类药物很少使用，可能是因为潜在的镇静副作用。只有极少数患者使用了曲坦类药物。还应特别注意在急诊科应用国际头痛疾病分类标准，这可以明确诊断并获得针对性治疗。
