engleski

Headache management in a neurological emergency room

Aims: Headache is a frequent complaint among patients in the ER. The aim of this study was to analyse the management of headache patients presenting to the emergency room (ER) at the University Hospital in Zagreb. Methods: A retrospective analysis of all patients with headache was carried out during 2007. Patients were analyzed according to the diagnoses, diagnostic procedures, treatment and further referral. Results:Among 6225 patients, 1385 (22.3%) complained of headache ; 894 (64.9%) women and 491 (35.4%) men.Migraine with or without aura, tension-type headache or cervicogenic headache had 1009 (72.9%) patients (67.3% women and 32.7% men) ; 84 (6%) had intracranial haemorrhage, 33 (2.3%) had primary tumour, 54 (3.8%) metastases, 193 (13.9%) head trauma, 7 (0.5%) head trauma with haemorrhage and 5 (0.4%) had an infectuouse disease. A diagnostic procedure was indicated in 413 (29.8%) of patients: 314 (22.7%) had a CT scan, 85 (6.1%) an EEG and 70 (5%) had an ultrasound examination. Patient referral was as follows: 1022 (73.8%) were dismissed home, 222 (16%) were referred to other clinics and 141 (10.2%) were hospitalized.Among patients with primary and cervicogenic headaches a diagnostic procedure was performed in 235 (23.2%) while 45 (4.5%) were hospitalized. Conclusions: Patients with primary headaches visit the ER in a relatively high number which represents a huge economical burden for the health system. Better treatment for these patients should be provided by GPs and neurologists in out-patient headache clinics.

headache; management; emergency room

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