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Recurrence of primary headache disorders after emergency department discharge: frequency and predictors of poor pain and functional outcomes.
Ann Emerg Med. 2008 Dec; 52(6):696-704.AE

Abstract

STUDY OBJECTIVE

We determine the frequency of moderate or severe headache during the first 24 hours after an emergency department (ED) visit for a primary headache disorder (such as migraine or tension-type headache), determine the burden of headache during the 3 months after the ED visit, and identify predictors of poor pain and functional outcomes after ED discharge for each of these periods.

METHODS

In this prospective cohort study, we enrolled headache patients during their initial ED visit, interviewed them by using a standardized questionnaire, and followed them by telephone 24 hours and 3 months after ED discharge. Two emergency physicians classified all headaches according to criteria established by the International Headache Society, using a valid questionnaire and a reproducible technique.

RESULTS

During an 18-month period, we enrolled 309 primary headache disorder patients in the cohort. The most common primary headache diagnoses assigned to patients were migraine, tension-type headache, and unclassifiable recurrent headache disorder. We successfully obtained follow-up in 94% of patients 24 hours after ED discharge and in 94% 3 months after ED discharge. Moderate or severe headache was present within 24 hours of ED discharge in 31% (95% confidence interval [CI] 25% to 38%) of migraine patients, 19% (95% CI 9% to 36%) of tension-type headache patients, and 27% (95% CI 18% to 38%) of the unclassifiable headache patients. Multiple functionally impairing headaches occurred during the 3 months after ED discharge in 37% of migraine patients (95% CI 30% to 44%), 38% of tension-type headache patients (95% CI 23% to 54%), and 26% of the unclassifiable headache patients (95% CI 17% to 37). After multivariate adjustment, independent predictors of poor 24-hour outcomes were severe baseline pain, baseline nausea, screening positive for depression, and longer duration of headache; the independent predictor of poor 3-month outcomes was Medicaid insurance.

CONCLUSION

Regardless of type of primary headache disorder, ED headache patients frequently experience pain and functional impairment during the hours and months after discharge.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Friedman BW
Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. befriedm@montefiore.org
Hochberg ML
No affiliation info available
Esses D
No affiliation info available
Grosberg BM
No affiliation info available
Rothberg D
No affiliation info available
Bernstein B
No affiliation info available
Bijur PE
No affiliation info available
Lipton RB
No affiliation info available
Gallagher EJ
No affiliation info available

MeSH

AdultAnalgesicsEmergency Service, HospitalFemaleFollow-Up StudiesHeadacheHumansMaleRecurrenceSeverity of Illness IndexTreatment Failure

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18387702

Clinical Trial Links

The CHECK Trial: A Comparison of Headache Treatment in the ED: Compazine Versus Ketamine

Citation

Friedman, Benjamin W., et al. "Recurrence of Primary Headache Disorders After Emergency Department Discharge: Frequency and Predictors of Poor Pain and Functional Outcomes." Annals of Emergency Medicine, vol. 52, no. 6, 2008, pp. 696-704.
Friedman BW, Hochberg ML, Esses D, et al. Recurrence of primary headache disorders after emergency department discharge: frequency and predictors of poor pain and functional outcomes. Ann Emerg Med. 2008;52(6):696-704.
Friedman, B. W., Hochberg, M. L., Esses, D., Grosberg, B. M., Rothberg, D., Bernstein, B., Bijur, P. E., Lipton, R. B., & Gallagher, E. J. (2008). Recurrence of primary headache disorders after emergency department discharge: frequency and predictors of poor pain and functional outcomes. Annals of Emergency Medicine, 52(6), 696-704. https://doi.org/10.1016/j.annemergmed.2008.01.334
Friedman BW, et al. Recurrence of Primary Headache Disorders After Emergency Department Discharge: Frequency and Predictors of Poor Pain and Functional Outcomes. Ann Emerg Med. 2008;52(6):696-704. PubMed PMID: 18387702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrence of primary headache disorders after emergency department discharge: frequency and predictors of poor pain and functional outcomes. AU - Friedman,Benjamin W, AU - Hochberg,Michael L, AU - Esses,David, AU - Grosberg,Brian M, AU - Rothberg,Daniel, AU - Bernstein,Benjamin, AU - Bijur,Polly E, AU - Lipton,Richard B, AU - Gallagher,E John, Y1 - 2008/04/03/ PY - 2007/08/14/received PY - 2007/12/13/revised PY - 2008/01/29/accepted PY - 2008/4/5/pubmed PY - 2008/12/19/medline PY - 2008/4/5/entrez SP - 696 EP - 704 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 52 IS - 6 N2 - STUDY OBJECTIVE: We determine the frequency of moderate or severe headache during the first 24 hours after an emergency department (ED) visit for a primary headache disorder (such as migraine or tension-type headache), determine the burden of headache during the 3 months after the ED visit, and identify predictors of poor pain and functional outcomes after ED discharge for each of these periods. METHODS: In this prospective cohort study, we enrolled headache patients during their initial ED visit, interviewed them by using a standardized questionnaire, and followed them by telephone 24 hours and 3 months after ED discharge. Two emergency physicians classified all headaches according to criteria established by the International Headache Society, using a valid questionnaire and a reproducible technique. RESULTS: During an 18-month period, we enrolled 309 primary headache disorder patients in the cohort. The most common primary headache diagnoses assigned to patients were migraine, tension-type headache, and unclassifiable recurrent headache disorder. We successfully obtained follow-up in 94% of patients 24 hours after ED discharge and in 94% 3 months after ED discharge. Moderate or severe headache was present within 24 hours of ED discharge in 31% (95% confidence interval [CI] 25% to 38%) of migraine patients, 19% (95% CI 9% to 36%) of tension-type headache patients, and 27% (95% CI 18% to 38%) of the unclassifiable headache patients. Multiple functionally impairing headaches occurred during the 3 months after ED discharge in 37% of migraine patients (95% CI 30% to 44%), 38% of tension-type headache patients (95% CI 23% to 54%), and 26% of the unclassifiable headache patients (95% CI 17% to 37). After multivariate adjustment, independent predictors of poor 24-hour outcomes were severe baseline pain, baseline nausea, screening positive for depression, and longer duration of headache; the independent predictor of poor 3-month outcomes was Medicaid insurance. CONCLUSION: Regardless of type of primary headache disorder, ED headache patients frequently experience pain and functional impairment during the hours and months after discharge. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/18387702/Recurrence_of_primary_headache_disorders_after_emergency_department_discharge:_frequency_and_predictors_of_poor_pain_and_functional_outcomes_ DB - PRIME DP - Unbound Medicine ER -