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Orsi S, Melhado EM, Zambelli BAK, Paternost BA, Farina JHF, Ferreira SG, Albuquerque TVC. Knowledge of the medical resident about diagnosis and treatment of patients with headache. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction
Considering the high prevalence of headache, it is necessary a study about the effectiveness of the care of patients with headache by medical resident in Emergency Care Units (EDU) and medical outpatient clinics.
Objective
The objective of this study was to analyze the effectiveness of care in EDUs, outpatient clinics and medical wards and the management of patients with headache complaints.
Method
The study was observational descriptive (cross-sectional cohort) through the application of an online questionnaire answered by the medical residents.
Results
There were 115 residents who answered the survey. In the group of residents who see patients with headache (n=95) the number of visits was 4.87 per week. The resident's idea is that headaches are symptoms of an underlying disease in 49.5% of them. On the question about feeling able to differentiate primary from secondary headaches, 50% of the residents said yes. On the question, "Is Migraine the same as Headache?" 6.1% answered yes. On the question, "Would you use morphine derivatives to treat headache?" 19.1% of the residents answered that they would. On the question about having knowledge about the harms of using morphine derivatives in headache, 60% answered that they did not have in-depth knowledge or that they have no knowledge. In this sample of residents, 74/115 (65%) suffer from headache. Only 36/115 (31%) of the residents sought care because of the headache. Of the residents, 3/115 (2.6%) have chronic daily headache. In the question about knowing what is "chronic daily headache" and from medication overuse, about 35% do not know or did not delve into the concept.
Conclusion
We conclude that there is a lack of teaching about types of headaches, criteria for diagnosis and treatment. Urgent modifications should be made in the medical course to enable newly graduated doctors to diagnose and treat patients with headache.
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Monteith TS. Advocacy for Migraine Relief: Strategic Planning to Eliminate the Burden. Curr Pain Headache Rep 2022; 26:567-574. [PMID: 35716274 PMCID: PMC9206221 DOI: 10.1007/s11916-022-01059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review The goal of this article is to describe migraine advocacy as an essential means to advance the field of headache medicine. Special attention is spent outlining advocacy initiatives and priorities. Recent Findings There is little written about “migraine advocacy” in the literature. However, organizational and expert priorities include advocating for policies that improve systems of care, telemedicine, education, research, and public initiatives that reduce health disparities and the stigma of migraine. Summary This summary includes the latest advocacy efforts to support policies that may improve migraine care, strengthen the field of headache medicine, and eliminate the burden of migraine.
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Kelly AM, Kuan WS, Chu KH, Kinnear FB, Keijzers G, Karamercan MA, Klim S, Wijeratne T, Kamona S, Graham CA, Body R, Roberts T, Horner D, Laribi S. Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)-A multinational observational study. Headache 2021; 61:1539-1552. [PMID: 34726783 DOI: 10.1111/head.14230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/06/2021] [Accepted: 07/23/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe the epidemiology of nontraumatic headache in adults presenting to emergency departments (EDs). BACKGROUND Headache is a common reason for presentation to EDs. Little is known about the epidemiology, investigation, and treatment of nontraumatic headache in patients attending EDs internationally. METHODS An international, multicenter, observational, cross-sectional study was conducted over one calendar month in 2019. Participants were adults (≥18 years) with nontraumatic headache as the main presenting complaint. Exclusion criteria were recent head trauma, missing records, interhospital transfers, re-presentation with same headache as a recent visit, and headache as an associated symptom. Data collected included demographics, clinical assessment, investigation, treatment, and outcome. RESULTS We enrolled 4536 patients (67 hospitals, 10 countries). "Thunderclap" onset was noted in 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 computed tomography (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 nonmigraine benign headache accounted for 45.4% of cases (2058/4536) with another 24.3% classified as migraine (1101/4536). A small subgroup of patients have a serious secondary cause for their headache (7.1%; 323/4536) with subarachnoid hemorrhage (SAH), stroke, neoplasm, non-SAH intracranial hemorrhage/hematoma, and meningitis accounting for about 1% each. Most patients were treated with simple analgesics (paracetamol, aspirin, or nonsteroidal anti-inflammatory agents). Most patients were discharged home (83.8%; 3792/4526). In-hospital mortality was 0.3% (11/4526). CONCLUSION Diagnosis and management of headache in the ED is challenging. A small group of patients have a serious secondary cause for their symptoms. There is wide variation in the use of neuroimaging and treatments. Further work is needed to understand the variation in practice and to better inform international guidelines regarding emergent neuroimaging and treatment.
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Affiliation(s)
- Anne Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Victoria, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kevin H Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Frances B Kinnear
- Emergency & Children's Services, The Prince Charles Hospital, Chermside, Queensland, Australia.,Department of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Victoria, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Health, St Albans, Victoria, Australia.,Public Health School, La Trobe University, Bundoora, Victoria, Australia
| | - Sinan Kamona
- School of Medicine, University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tom Roberts
- Trainee Emergency Research Network (TERN), Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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Abril Ochoa L, Naeem F, White DJ, Bijur PE, Friedman BW. Opioid-induced Euphoria Among Emergency Department Patients With Acute Severe Pain: An Analysis of Data From a Randomized Trial. Acad Emerg Med 2020; 27:1100-1105. [PMID: 32220099 DOI: 10.1111/acem.13946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/01/2020] [Accepted: 02/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parenteral opioids are commonly used to treat acute severe pain. We measured pleasurable sensations in patients administered intravenous analgesics to determine if these sensations were associated with receipt of an opioid, after controlling for relief of pain. Pleasurable sensations not accounted for by relief of pain were considered opioid-induced euphoria. METHODS These data were from a randomized study of 1 mg of hydromorphone versus 120 mg of lidocaine for abdominal pain. To assess euphoria, participants were asked to provide a 0 to 10 response to each of these questions: 1) How good did the medication make you feel? 2) How high did the medication make you feel? and 3) How happy did the medication make you feel? Pain at baseline and 30 minutes was also measured on a 0 to 10 scale. To determine the relative importance of pain relief versus medication type, we built three linear regression models in which each euphoria question was the dependent variable and pain relief, medication type, and medication-induced side effects were the independent variables. RESULTS Seventy-seven patients received lidocaine and 77 hydromorphone. Hydromorphone patients reported greater pain improvement than lidocaine patients (mean difference = 1.5, 95% confidence interval [CI] = 0.6 to 2.3) and higher scores on all three euphoria questions ("feeling good" difference = 1.9, 95% CI = 0.8 to 3.0; "feeling high" difference = 1.5, 95% CI = 0.4 to 2.7; "feeling happy" difference = 1.7, 95% CI = 0.6 to 2.8). In the regression models, hydromorphone administration (β-coefficient = 0.16, p = 0.03) and pain relief (β-coefficient = 0.45, p < 0.01) were both associated with "feeling good." "Feeling high" and "feeling happy" were associated with pain improvement (p < 0.01) but not with hydromorphone administration (p = 0.07 for "high" and p = 0.06 for "happy"). Medication-induced side effects were not associated with these measures of euphoria. CONCLUSION Among emergency department patients with acute pain, hydromorphone-induced euphoria, though measurable, was generally less important for patients than relief of pain.
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Affiliation(s)
- Lorena Abril Ochoa
- From the Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY
| | - Farnia Naeem
- and the Medical College Albert Einstein College of Medicine Bronx NY USA
| | - Deborah J. White
- From the Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY
| | - Polly E. Bijur
- From the Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY
| | - Benjamin W. Friedman
- From the Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY
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Jarvis JL, Johnson B, Crowe RP. Out-of-hospital assessment and treatment of adults with atraumatic headache. J Am Coll Emerg Physicians Open 2020; 1:17-23. [PMID: 33000009 PMCID: PMC7493518 DOI: 10.1002/emp2.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Little is known about the presentation or management of patients with headache in the out-of-hospital setting. Our primary objective is to describe the out-of-hospital assessment and treatment of adults with benign headache. We also describe meaningful pain reduction stratified by commonly administered medications. METHODS This retrospective evaluation was conducted using data from a large national cohort. We included all 911 responses by paramedics for patients 18 and older with headache. We excluded patients with trauma, fever, suspected alcohol/drug use, or who received medications suggestive of an alternate condition. We presented our findings with descriptive statistics. RESULTS Of the 5,977,612 emergency responses, 1.1% (66,235) had a provider-documented primary impression of headache or migraine and 52.5% (34,763) met inclusion criteria. An initial pain score was recorded for 73.5% (25,544) of patients, and 58.5% (14,948) of these patients had multiple pain scores documented. Of the patients with multiple pain scores documented, 53.8% (8037) of patients had an initial pain score >5. Of these, 7.1% (573) were administered any medication. Among patients receiving a single medication, Fentanyl was the most commonly administered (32.1%, 126). As a group, opioids were the most commonly administered class of drugs (38.9%, 153) and were associated with the largest proportion of clinically significant pain reduction (69.3%, 106). Dopamine antagonists were given least frequently (9.9%, 39) but had the second largest proportion of pain reduction (43.6%, 17). CONCLUSION Out-of-hospital pain scores were documented infrequently and less than one in five patients with initial pain scores >5 received medication. Additionally, adherence to evidence-based guidelines was infrequent.
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Affiliation(s)
- Jeffrey L. Jarvis
- Williamson County EMSGeorgetownTexasUSA
- Department of Emergency MedicineBaylor Scott & White HealthcareTempleTexasUSA
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