Headache in the emergency department.
OBJECTIVE
To perform an observational study of the demographics, clinical factors, and therapeutic efficacy in patients presenting to the emergency department with a chief complaint of headache.


BACKGROUND
Acute headache presentations to the emergency department are a therapeutic dilemma for physicians.


METHODS
Patients presenting with nontraumatic headache to the emergency department of Hermann Hospital in Houston, Texas, during a 16-month period were prospectively ascertained by active and passive surveillance. The medical record was abstracted. Demographic and clinical information are presented with descriptive statistics. Relative benefit of individual therapies are compared with odds ratios (95% confidence intervals).


RESULTS
Of the 38 730 patients who were prospectively screened, 455 presented with a chief complaint of headache. Seventy-six percent were women, and the mean age was 37 years. Non-Hispanic whites were more likely diagnosed with migraine compared with Hispanics or African Americans (P<.001). Three percent had subarachnoid hemorrhage. Neurologist follow-up was ordered in 10%. The median time in the emergency department was 265 minutes. With the initial treatment, 44% resolved, 47% improved, and 9% had no change; none worsened. In comparison with all other therapies used, there was a trend suggesting the superiority of antiemetics (odds ratio, 2.66; 95% confidence interval, 0.81 to 8.61). Acetaminophen was less helpful (odds ratio, 0.27; 95% confidence interval, 0.10 to 0.70). When comparing specific agents to therapies which could be used at home, antiemetics led to headache resolution most often (odds ratio, 3.18; 95% confidence interval, 1.40 to 7.22); ketorolac showed a similar trend (odds ratio, 2.05; 95% confidence interval, 0.86 to 4.89).


CONCLUSIONS
Headache in the emergency department is a phenomena of young women who spend a long time waiting and receive many tests. A variety of therapies are used. Antiemetics may be especially useful for headache resolution.
Morgenstern
L B
LB
Department of Neurology, University of Texas Medical School, Houston 77030, USA.
Huber
J C
JC
Luna-Gonzales
H
H
Saldin
K R
KR
Grotta
J C
JC
Shaw
S G
SG
Knudson
L
L
Frankowski
R F
RF
D000208:Acute Disease; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006261:Headache / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy; D011346:Prochlorperazine / Q000627:therapeutic use; D011446:Prospective Studies; D013781:Texas; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D011346:Prochlorperazine; D020910:Ketorolac