Abstract
Background: Although patients with acute headache frequently present in emergency department, the causes and predictors of short-term outcome in patients with acute headache in general neurology have not been adequately investigated. Methods: We prospectively reviewed the medical records of 130 hospitalized acute headache pa-tients in general neurology of China. Their initial CT scan was assessed, as was their lumbar puncture (LP) examination if performed. Results: The main cause of acute headache was acute secondary headache (80.8%), which was mainly attributable to acute cerebrovascular events (72.4%) followed by intracranial infection (19.0%). Among the 10.8% of patients who died during hospitalization most (85.7%) had subarachnoid hemorrhage (SAH). Significant predictors of survival were severe headache versus thunderclap headache, meningismus, de-layed loss of consciousness, and hypertension (all p < 0.05). Multiple logistic regression analyses showed significant differences in severe headache or thunderclap headache (OR, 0.255; 95%CI, 0.066 - 0.990; p = 0.048) and delayed loss of consciousness (OR, 0.060; 95%CI, 0.016 - 0.224, p = 0.000) between patients who died and those who survived. Conclusions: The main underlying cause of hospitalized acute headache was acute cerebrovascular events. Severe headache and delayed loss of consciousness are predictors for poor outcome of acute headache.
Highlights
Acute headache is a common neurological emergency that may be caused by a great variety of clinical conditions
In our 130 patients diagnosed according to International Classification of Headache Disorders (ICHD) standards secondary headache was the major cause of acute headache for hospitalization, in 80.8%, including acute cerebrovascular events in 72.4%, intracranial infection in 19.0%, and a few other causes
In our cohort the proportion with secondary headache and acute cerebrovascular events was significantly higher than previously observed in emergent patients in neurology departments reported in Canada and Norway [2,3], and cerebrovascular events were significantly higher than in patients hospitalized in Minnesota [9]
Summary
Acute headache (primary and secondary) is a common neurological emergency that may be caused by a great variety of clinical conditions. The aims of the study were to investigate underlying causes of acute headache and to determine predictors of outcome in patients with acute headache. Patients with acute headache frequently present in emergency department, the causes and predictors of short-term outcome in patients with acute headache in general neurology have not been adequately investigated. Methods: We prospectively reviewed the medical records of 130 hospitalized acute headache patients in general neurology of China. Their initial CT scan was assessed, as was their lumbar puncture (LP) examination if performed. Multiple logistic regression analyses showed significant differences in severe headache or thunder-clap headache (OR, 0.255; 95%CI, 0.066 - 0.990; p = 0.048) and delayed loss of consciousness (OR, 0.060; 95%CI, 0.016 - 0.224, p = 0.000) between patients who died and those who survived. Severe headache and delayed loss of consciousness are predictors for poor outcome of acute headache
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