Headache investigation snapshot Queensland

Abstract

Introduction: Headache is a frequent ED presentation with infrequent but potentially life-threatening causes. Objectives: To describe the presentation, investigation and diagnosis of patients presenting to the ED complaining of a headache. Method: A prospective observational study was conducted across 34 EDs (public & private) in Queensland over 4weeks in September 2014. Patients ≥18years presenting with a headache or clinical features suggestive of a subarachnoid haemorrhage (SAH) were included. The treating doctor collected details about the headache. A research officer abstracted data on investigations and diagnosis from state-wide databases. Results: 912 presentations were recorded for 860 patients. 51% presented to a principal referral, 45% to a city or regional and 4% to a private hospital. Median (range) age was 40 (18-92) years. 62%werewomen. 60%were triaged from 08:00 to 17:59 hours and 25% from 18:00 to 23:59 hours. 31% arrived by ambulance. Headache onset to peak intensity was ≤1 hour in 44.5% and worst ever in 36.0%. 61.9% had a past history of headaches, and in 33.1% of these, the current headache was different from the past. GCS was <15 in 4.0% and temperature ≥38 °C in 3.2%. 2.4%was transferred to another facility. CT head scan and lumbar puncture were performed in 36.9% and 4.9%, respectively. 4.1% had a CT angiogram. There were 18 atraumatic SAH, 6 other intracranial haemorrhage, 2 bacterial meningitis and 4 brain tumours. Conclusion: Life-threatening causes of headache are infrequent but not insignificant and will remain a diagnostic challenge for emergency physicians.<br />