Epidemiology of adult patients with headache presenting to emergency departments (The HEAD study)

Not Applicable

Completed

• Conditions: Headache in adults; Migraine; Neurological - Other neurological disorders

• Registration Number: ACTRN12619000094178
• Lead Sponsor: Anne-Maree Kelly

Brief Summary

We enrolled 4536 patients (67 hospitals, 10 countries). ‘Thunderclap’ onset was noted for 14.2% of cases (644/4536). Headache was rated as severe in 27.2% (1235/4536). New neurological examination findings were uncommon (3.2%; 147/4536). Head CT was performed in 36.6% of patients (1661/4536), of which 9.9% showed clinically important pathology (165/1661). There was substantial variation in CT scan utilization between countries (15.9%-75.0%). More than 30 different diagnoses were made. Presumed non-migraine benign headache accounted for 45.4% of cases (2058/4536) with another 24.3% classified as migraine (1101/4536). A small sub-group have a serious cause for their headache (7.1%; 323/4536) with subarachnoid haemorrhage (SAH), stroke, neoplasm, non-SAH intracranial haemorrhage/haematoma and meningitis accounting for about 1% each. Most patients were treated with simple analgesics (paracetamol, aspirin or non-steroidal anti-inflammatory agents). Most patients were discharged home (83.8%; 3792/4526). In-hospital mortality was 0.3% (11/4526).

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Study Start: 2019-01-22
• Study Completion: 2019-12-01
• Last Update Posted: 26 September 2023

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 4536

Inclusion Criteria

Adult patients (18 or older) with a primary ED presenting problem of headache

Exclusion Criteria

•History of trauma within 48 hours of presentation
•Missing medical records
•Inter-hospital transfers
•Representation with same headache as previous visit
•Headache as an associated symptom rather than main complaint

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Distribution of diagnoses (from a coded list). Determined by the treating doctor's coding of final emergency department diagnosis as per the ED data management system and the clinical record.[ In ED];Distribution of medications administered to participants (from a coded list). Determined by drugs administered as per participant's medication chart..[ in ED];Disposition from the emergency department. Determined by discharge destination field on emergency department data management system[ in ED]

Secondary Outcome Measures

Name	Time	Method
The proportion of patients having a CT scan as part of their investigations. Determined by CT scan recorded in participants medical record[ in ED];In hospital mortality, determined by discharge destination in hospital data management system[ During hospital stay]