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Membrilla JA, Alpuente A, Gómez-Dabo L, Raúl GY, Mariño E, Díaz-de-Terán J, Pozo-Rosich P. "Code Headache": Development of a protocol for optimizing headache management in the emergency room. Eur J Neurol 2024:e16484. [PMID: 39287050 DOI: 10.1111/ene.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND AND PURPOSE Patients presenting at the emergency room (ER) with headache often encounter a hostile atmosphere and experience delays in diagnosis and treatment. The aim of this study was to design a protocol for the ER with the goal of optimizing the care of patients with urgent headache to facilitate diagnosis and expedite treatment. METHODS A narrative literature review was conducted via a MEDLINE search in October 2021. The "Code Headache" protocol was then developed considering the available characteristics and resources of the ER at a tertiary care center within the Spanish National Public Health system. RESULTS The Code Headache protocol comprises three assessments: two scales and one checklist. The assessments identify known red flags and stratify patients based on suspected primary/secondary headaches and the need for pain treatment. Initial assessments, performed by the triage nurse, aim to first exclude potentially high morbidity and mortality etiologies (HEAD1 scale) and then expedite appropriate pain management (HEAD2 scale) based on scoring criteria. HEAD1 evaluates vital signs and symptoms of secondary serious headache disorders that can most benefit from earlier identification and treatment, while HEAD2 assesses symptoms indicative of status migrainosus, pain intensity, and vital signs. Subsequently, ER physicians employ a third assessment that reviews red flags for secondary headaches (grouped under the acronym 'PEACE') to guide the selection of complementary tests and aid diagnosis. CONCLUSIONS The Code Headache protocol is a much needed tool to facilitate quick clinical assessment and improve patient care in the ER. Further validation through comparison with standard clinical practice is warranted.
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Affiliation(s)
- Javier A Membrilla
- Department of Neurology, Hospital Universitari Francesc de Borja, Gandía, Spain
| | - Alicia Alpuente
- Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neurology, Headache Clinic, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Gómez-Dabo
- Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - García-Yu Raúl
- Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - Eduardo Mariño
- Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Díaz-de-Terán
- Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid - Getafe Universitary Hospital - Universidad Europea de Madrid), Madrid, Spain
| | - Patricia Pozo-Rosich
- Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neurology, Headache Clinic, Vall d'Hebron University Hospital, Barcelona, Spain
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Waliszewska-Prosół M, Montisano DA, Antolak M, Bighiani F, Cammarota F, Cetta I, Corrado M, Ihara K, Kartamysheva R, Petrušić I, Pocora MM, Takizawa T, Vaghi G, Martelletti P, Corso B, Raggi A. The impact of primary headaches on disability outcomes: a literature review and meta-analysis to inform future iterations of the Global Burden of Disease study. J Headache Pain 2024; 25:27. [PMID: 38433202 PMCID: PMC10910736 DOI: 10.1186/s10194-024-01735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The burden and disability associated with headaches are conceptualized and measured differently at patients' and populations' levels. At the patients' level, through patient-reported outcome measures (PROMs); at population level, through disability weights (DW) and years lived with a disability (YLDs) developed by the Global Burden of Disease Study (GBD). DW are 0-1 coefficients that address health loss and have been defined through lay descriptions. With this literature review, we aimed to provide a comprehensive analysis of disability in headache disorders, and to present a coefficient referring to patients' disability which might inform future GBD definitions of DW for headache disorders. METHODS We searched SCOPUS and PubMed for papers published between 2015 and 2023 addressing disability in headache disorders. The selected manuscript included a reference to headache frequency and at least one PROM. A meta-analytic approach was carried out to address relevant differences for the most commonly used PROMs (by headache type, tertiles of medication intake, tertiles of females' percentage in the sample, and age). We developed a 0-1 coefficient based on the MIDAS, on the HIT-6, and on MIDAS + HIT-6 which was intended to promote future DW iterations by the GBD consortium. RESULTS A total of 366 studies, 596 sub-samples, and more than 133,000 single patients were available, mostly referred to cases with migraine. Almost all PROMs showed the ability to differentiate disability severity across conditions and tertiles of medication intake. The indexes we developed can be used to inform future iterations of DW, in particular considering their ability to differentiate across age and tertiles of medication intake. CONCLUSIONS Our review provides reference values for the most commonly used PROMS and a data-driven coefficient whose main added value is its ability to differentiate across tertiles of age and medication intake which underlie on one side the increased burden due to aging (it is likely connected to the increased impact of common comorbidities), and by the other side the increased burden due to medication consumption, which can be considered as a proxy for headache severity. Both elements should be considered when describing disability of headache disorders at population levels.
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Affiliation(s)
| | - Danilo Antonio Montisano
- Dipartimento Di Neuroalgologia, Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Mariola Antolak
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Federico Bighiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Francescantonio Cammarota
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Ilaria Cetta
- Neuroimaging Research Unit and Neurology Unit, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Corrado
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Japanese Red Cross, Ashikaga Hospital, Tochigi, Japan
| | - Regina Kartamysheva
- Department of Neurology, University Clinic of Kazan Federal University, Kazan, Russian Federation
| | - Igor Petrušić
- Faculty of Physical Chemistry, Laboratory for Advanced Analysis of Neuroimages, University of Belgrade, Belgrade, Serbia
| | - Maria Magdalena Pocora
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Barbara Corso
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Alberto Raggi
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Chandrashekhar H, Arman S, Khan J, Kalladka M. Lymphoma masquerading as jaw pain, headache, and syncope: A case report. J Am Dent Assoc 2024; 155:79-88. [PMID: 37389534 DOI: 10.1016/j.adaj.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/04/2023] [Accepted: 03/22/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Lymphomas of parapharyngeal space often have complex manifestations, posing a diagnostic dilemma for clinicians. CASE DESCRIPTION A 64-year-old man sought treatment for a 4-month history of unresolving right-sided headache and jaw pain associated with syncope, all of which started with a toothache. Since the onset of pain, the patient had undergone multiple diagnostic tests with various specialists, with no pain relief. A detailed clinical and radiologic examination by an orofacial pain specialist revealed diffuse large B-cell lymphoma in the parapharynx. PRACTICAL IMPLICATIONS A thorough knowledge of the head and neck anatomy helps in identifying the pathophysiology of complex orofacial pain manifestations, which assists in early diagnosis and treatment.
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Chu K, Kelly AM, Keijzers G, Kinnear F, Kuan WS, Graham C, Laribi S, Roberts T, Karamercan M, Cardozo-Ocampo A, Kamona S, Body R, Horner D, Klim S, Brown N, Wijeratne T. Computed tomography brain scan utilization in patients with headache presenting to emergency departments: a multinational study. Eur J Emerg Med 2023; 30:356-364. [PMID: 37310953 DOI: 10.1097/mej.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND IMPORTANCE Recommended indications for emergency computed tomography (CT) brain scans are not only complex and evolving, but it is also unknown whether they are being followed in emergency departments (EDs). OBJECTIVE To determine the CT utilization and diagnostic yield in the ED in patients with headaches across broad geographical regions. DESIGN Secondary analysis of data from a multinational cross-sectional study of ED headache presentations over one month in 2019. SETTING AND PARTICIPANTS Hospitals from 10 participating countries were divided into five geographical regions [Australia and New Zealand (ANZ); Colombia; Europe: Belgium, France, UK, and Romania; Hong Kong and Singapore (HKS); and Turkey). Adult patients with nontraumatic headache as the primary presenting complaint were included. Patients were identified from ED management systems. OUTCOME MEASURES AND ANALYSIS The outcome measures were CT utilization and diagnostic yield. CT utilization was calculated using a multilevel binary logistic regression model to account for clustering of patients within hospitals and regions. Imaging data (CT requests and reports) were sourced from radiology management systems. MAIN RESULTS The study included 5281 participants. Median (interquartile range) age was 40 (29-55) years, 66% were women. Overall mean CT utilization was 38.5% [95% confidence interval (CI), 30.4-47.4%]. Regional utilization was highest in Europe (46.0%) and lowest in Turkey (28.9%), with HKS (38.0%), ANZ (40.0%), and Colombia (40.8%) in between. Its distribution across hospitals was approximately symmetrical. There was greater variation in CT utilization between hospitals within a region than between regions (hospital variance 0.422, region variance 0.100). Overall mean CT diagnostic yield was 9.9% (95% CI, 8.7-11.3%). Its distribution across hospitals was positively skewed. Regional yield was lower in Europe (5.4%) than in other regions: Colombia (9.1%), HKS (9.7%), Turkey (10.6%), and ANZ (11.2%). There was a weak negative correlation between utilization and diagnostic yield ( r = -0.248). CONCLUSION In this international study, there was a high variation (28.9-46.6%) in CT utilization and diagnostic yield (5.4-11.2%) across broad geographic regions. Europe had the highest utilization and the lowest yield. The study findings provide a foundation to address variation in neuroimaging in ED headache presentations.
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Affiliation(s)
- Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane
- Faculty of Medicine, University of Queensland, Queensland
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast
- School of Medicine, Bond University, Gold Coast
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Colin Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Said Laribi
- Department of Emergency Medicine, Tours University Hospital, Tours, France
| | - Tom Roberts
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Mehmet Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Sinan Kamona
- Adult Emergency Department, Auckland City Hospital
- Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Richard Body
- Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust
- Division of Cardiovascular Science, University of Manchester, Manchester
| | - Daniel Horner
- Emergency Department, Northern Care Alliance NHS Foundation Trust, Salford
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria
| | - Nathan Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane
- Faculty of Medicine, University of Queensland, Queensland
| | - Tissa Wijeratne
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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Hugger SS, Do TP, Ashina H, Goicochea MT, Jenkins B, Sacco S, Lee MJ, Brennan KC, Amin FM, Steiner TJ, Ashina M. Migraine in older adults. Lancet Neurol 2023; 22:934-945. [PMID: 37717587 DOI: 10.1016/s1474-4422(23)00206-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/20/2023] [Accepted: 05/23/2023] [Indexed: 09/19/2023]
Abstract
Migraine is an evolving, and sometimes lifelong disorder. The prevalence of episodic migraine peaks among individuals aged in their late 30s, implying a tendency for the disorder to remit with increasing age thereafter, whereas chronic migraine is more likely to persist into later life. Diagnosis and treatment of migraine in older adults, defined as individuals aged 60 years or older, is rendered more complex by increasing probabilities of atypical clinical features and comorbidities, with patients' comorbidities sometimes limiting their therapeutic options. However, the changing clinical presentation of migraine over an individual's lifespan is not well characterised. The neurobiological basis of remission in older adults remains unclear, although vascular, neuronal, and hormonal changes are likely to be involved. Long-term longitudinal studies of individuals with migraine would be particularly informative, with the potential not only to suggest new research directions, but also to lead to the identification of novel therapeutic agents. Although several novel migraine medications are becoming available, their effectiveness, tolerability, and safety often remain uncertain in older adults, who have commonly been excluded from the evaluation of these agents in randomised controlled trials, or who constitute only a small proportion of study populations. There is a need to recognise these limitations in the available evidence, and the specific, and often unmet, clinical needs of older adults with migraine, not least because older adults constitute an increasing proportion of populations worldwide.
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Affiliation(s)
- Sarah Sonja Hugger
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Thien Phu Do
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - K C Brennan
- Headache Physiology Laboratory, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Timothy J Steiner
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Yalinay Dikmen P, Ozge A, Martelletti P. The use of clinical scales and PROMs in headache disorders and migraine, summarizing their dissemination and operationalization. Heliyon 2023; 9:e16187. [PMID: 37251845 PMCID: PMC10220237 DOI: 10.1016/j.heliyon.2023.e16187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Measurements are an essential aspect of scientific research. This review will present clinical scales and patient-reported outcome measures (PROMs) for headache disorders and migraine that have been endorsed by the International Headache Society (IHS) and are intended for use by both physicians and researchers. A clinical scale is a tool to assess a patient's condition or symptoms in a standardized and quantifiable way. Clinical scales are often used in research settings and can be used to track a patient's progress over time, monitor the effectiveness of treatment, and make decisions. They can be self-administered or completed by a healthcare professional. PROMs are tools used to evaluate a patient's health status, symptoms, and quality of life. These measures are completed by the patient and provide valuable information about the patient's perspective and experience of their condition. PROMs are increasingly used in clinical practice and research to improve patient-centered care, patient engagement, and shared decision-making. This review also briefly covers the creation process, testing for reliability and validity, and interpreting the results of the use of clinical scales and PROMs in clinical and research settings in headache disorders. The first step in creating a clinical scale or PROM is to define the purpose of the scale and the population it is intended to assess. The next step is to identify the domains or areas that the scale will assess. Then, the items or questions that will be included in the scale need to be developed. These items should be relevant to the defined purpose and population of the scale and should be worded clearly and concisely. After the items have been developed, the scale or PROM can be administered to a sample of individuals in the target population. This allows researchers to assess the reliability and validity of the scale or PROM, as well as to make any necessary revisions.
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Affiliation(s)
- Pınar Yalinay Dikmen
- Department of Neurology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Aynur Ozge
- Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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García-Azorín D, Abelaira-Freire J, González-García N, Rodriguez-Adrada E, Schytz HW, Barloese M, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Sensitivity of the SNNOOP10 list in the high-risk secondary headache detection. Cephalalgia 2022; 42:1521-1531. [PMID: 36003002 DOI: 10.1177/03331024221120249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the diagnostic accuracy of the SNNOOP10 list in the detection of high-risk headaches. METHODS Patients that visited the Hospital Clínico San Carlos (Madrid) emergency department due to headache that were allocated to a Manchester Triage System level between critical and urgent were prospectively included but retrospectively analysed. A researcher blind to the patients' diagnosis administered a standardised questionnaire and afterwards a neurologist blind to the questionnaire results diagnosed the patient according to the International Classification of Headache Disorders. The primary endpoint was to assess the sensitivity of the SNNOOP10 list in the detection of high-risk headaches. Secondary endpoints included the evaluation of the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of each SNNOOP10 item. RESULTS Between April 2015 and October 2021, 100 patients were included. Patients were 44 years old (inter-quartile range: 33.6-64.7) and 57% were female. We identified 37 different diagnoses. Final diagnosis was a primary headache in 33%, secondary headache in 65% and cranial neuralgia in 2%. There were 46 patients that were considered as having high-risk headache. Patients from the primary headache group were younger and more frequently female. Sensitivity of SNNOOP10 list was 100% (95% confidence interval: 90.2%-100%). The items with higher sensitivity were neurologic deficit or disfunction (75.5%), pattern change or recent onset of the headache (64.4%), onset after 50 years (64.4%). The most specific items were posttraumatic onset of headache (94.5%), neoplasm in history (89.1%) and systemic symptoms (89%). The area under the curve of the SNNOOP10 list was 0.66 (95% CI: 0.55-0.76). CONCLUSION The red flags from the SNNOOP10 list showed a 100% sensitivity in the detection of high-risk headache disorders.
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Affiliation(s)
- David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Nuria González-García
- Headache Unit, Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Henrik Winther Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Barloese
- Center for Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ángel Luis Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.,Institute of Biomedical Research of Salamanca (Ibsal), Salamanca, Spain
| | - Jesús Porta-Etessam
- Neurology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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Do TP, Dømgaard M, Stefansen S, Kristoffersen ES, Ashina M, Hansen JM. Barriers and gaps in headache education: a national cross-sectional survey of neurology residents in Denmark. BMC MEDICAL EDUCATION 2022; 22:233. [PMID: 35365132 PMCID: PMC8976293 DOI: 10.1186/s12909-022-03299-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/28/2022] [Indexed: 05/08/2023]
Abstract
BACKGROUND A major barrier to adequate headache care is the relative lack of formal education and training of healthcare professionals. Concerted efforts should be made to pinpoint major gaps in knowledge in healthcare professionals to facilitate better educational policies in headache training. The aim of this study was to identify deficiencies and barriers in headache training among residents in neurology in Denmark. METHODS We conducted a national cross-sectional survey of residents in neurology in Denmark from April 2019 to September 2019. The survey included questions on participant demographics, knowledge of and barriers in headache disorders, guidelines and diagnostic tools usage, contact with primary and tertiary care, medication overuse, and non-pharmacological interventions. Furthermore, respondents were asked to provide a ranked list from most to least interesting for six sub-specializations/disorders, i.e., cerebrovascular disease, dementia, epilepsy, headache, multiple sclerosis, Parkinson's disease. RESULTS Sixty (40%) out of estimated a population of ~ 150 resident across Denmark accepted the invitation. Of these, 54/60 (90%) completed the survey. Although two-thirds, 35/54 (65%), of the respondents had prior formalized training in headache disorders, we identified gaps in all explored domains including diagnosis, management, and referral patterns. Particularly, there was an inconsistent use of guidelines and diagnostic criteria from the Danish Headache Society (2.74 (± 1.14)), the Danish Neurological Society (3.15 (± 0.86)), and the International Classification of Headache Disorders (2.33 (± 1.08)); 1: never/have not heard of, 4: always. Headache was ranked second to last out of six sub-specializations in interest. CONCLUSIONS Overall knowledge on headache disorders amongst neurology residents in Denmark do not meet the expectations set out by national and international recommendations. Stakeholders should make strategic initiatives for structured education in headache for improved clinical outcomes in parallel with costs reduction through resource optimization.
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Affiliation(s)
- Thien Phu Do
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Mikala Dømgaard
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Simon Stefansen
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Jakob Møller Hansen
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark.
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YÜKSEL H, TUTAL GÜRSOY G, BEKTAŞ H. Significant and nonsignificant findings on magnetic resonance imaging of patients with headache. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1070220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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