title: Pain treatment and relief among patients with primary headache subtypes in the ED.
abstract: OBJECTIVE
  The aim of this study is to determine if emergency physicians treat headache subtypes differently and if this difference affects pain relief.
  
  
  METHODS
  This was a prospective observational, institutional review board-approved study of adults undergoing treatment for a primary headache. Before the treatment and 60 minutes after, patients completed a 100-mm Visual Analog Scale (VAS) describing their pain. Patients also completed a headache diagnosis worksheet that differentiated headache type based on International Headache Society criteria. Treatments were recorded. Data were analyzed using descriptive statistics, 95% confidence intervals, analysis of variance, and chi(2) tests as appropriate.
  
  
  RESULTS
  A total of 184 patients were enrolled: 83 (45.1%) with migraine, 61 (33.2%) with migrainous, and 40 (21.7%) with tension-type headaches. There was no difference in the presenting VAS score or treatments of the 3 headache subtypes. The migraine group was most likely to receive any pain medication (78.31%), and the tension group the least likely to receive any pain medication (62.50%). A 50% decrease in VAS was achieved by only 32.5% of the patients. Sumatriptan, followed by droperidol, provided the greatest decrease in VAS scores. Oral and parenteral narcotics provided equivalent pain relief, with nonsteroidal anti-inflammatory drugs (NSAIDs) providing the least pain relief.
  
  
  CONCLUSIONS
  There was no difference in the treatments used or pain relief achieved between migraine, migrainous, and tension-type headaches. The differentiation of primary headache subtypes does not appear to be important to their treatment in the acute setting of the emergency department.
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
authors.forename: Arleigh
authors.initials: A
authors.lastname: Trainor
authors.forename: James
authors.initials: J
authors.lastname: Miner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004329:Droperidol / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006261:Headache / Q000145:classification / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000145:classification / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D018170:Sumatriptan / Q000627:therapeutic use*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D018170:Sumatriptan; D004329:Droperidol