Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Internal Medicine Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Sci Rep. 2020 Feb 12;10(1):2446. doi: 10.1038/s41598-020-59171-4.
Headache is a common reason to visit the emergency department (ED). Tension-type headache (TTH) is the commonest headache. The diagnosis of TTH implies a mild condition, with no need for special tests. We evaluated the use of the International Classification of Headache Disorders (ICHD) criteria for TTH in the ED. We performed a cross-sectional study including all ED patients with a definite TTH diagnosis in their discharge report for 2.5 years. We evaluated whether the ICHD criteria for TTH were referenced and met. We analysed discrepancies concerning anamnesis or prior history and reclassified patients. A total of 211 out of 2132 patients fulfilled the criteria (9.9%). Only five patients fulfilled TTH criteria. Criteria A-D were referenced in 60-84% of patients and met in 16-74% of these patients. Anamnesis was discrepant in 87.5% as was prior history in 20.8%. After re-reclassification, 21 patients fulfilled the criteria for TTH (five) or probable TTH (16). In 106 patients, another headache was diagnosed, with migraine in 40 (18.9%), secondary headache in 64 (30.3%), and a life-threatening disorder in 13 (6.1%). In our sample, TTH was overdiagnosed. Only a minority of patients fulfilled the ICHD criteria. Inconsistencies in prior medical history or anamnesis were frequent.
头痛是前往急诊部（ED）的常见原因。紧张型头痛（TTH）是最常见的头痛。TTH 的诊断意味着病情较轻，无需特殊检查。我们评估了国际头痛疾病分类（ICHD）标准在 ED 中用于 TTH 的情况。我们进行了一项横断面研究，包括 2.5 年内所有在出院报告中明确诊断为 TTH 的 ED 患者。我们评估了 ICHD TTH 标准是否被引用并符合标准。我们分析了病史或既往病史的差异并重新分类了患者。在 2132 名患者中有 211 名符合标准（9.9%）。仅有 5 名患者符合 TTH 标准。A-D 标准在 60-84%的患者中被引用，在这些患者中有 16-74%符合标准。病史在 87.5%的患者中存在差异，既往病史在 20.8%的患者中存在差异。重新分类后，21 名患者符合 TTH（5 名）或可能 TTH（16 名）的标准。在 106 名患者中，诊断出另一种头痛，其中偏头痛 40 例（18.9%），继发性头痛 64 例（30.3%），危及生命的疾病 13 例（6.1%）。在我们的样本中，TTH 被过度诊断。只有少数患者符合 ICHD 标准。既往病史或病史存在差异的情况很常见。
