Abstract
Stress induced by the events of daily life is considered a major factor in pathogenesis of primary tension-type headache. Little is known about the impact that could have a more stressful event, like a natural disaster, both in patients with chronic headache, both in people that do not had headache previously. The aim of the present study was to observe the prevalence of headache in the population following the devastating earthquake that affected the province of L’Aquila on April 6, 2009. The study population was conducted in four tent cities (Onna, Bazzano, Tempera-St. Biagio, Paganica). Sanitary access is recorded in the registers of medical triage, in the first 5 weeks, after the April 6, 2009. The prevalence of primary headache presentation was 5.53% (95% CI 4.2–7.1), secondary headache was 2.82% (95% CI 1.9–4.9). Pain intensity, assessed by Numerical Rating Scale score showed a mean value of 7 ± 1.1 (range 4–10). The drugs most used were the NSAIDs (46%) and paracetamol (36%), for impossibility of finding causal drugs. This study shows how more stressful events not only have an important role in determining acute exacerbation of chronic headache, but probably also play a pathogenic role in the emergence of primary headache. Also underlines the lack of diagnostic guidelines or operating protocols to early identify and treat headache in the emergency settings.
Highlights
MethodsThe present observational study was carried out in four Advanced Medical Presidiums (AMPs) that were present in tent camps included in seven Mixed Operating Centers (MOC) operating in the area of L’Aquila during a 5-week period after the earthquake (from April 7 to May 11, 2009)
This study shows how more stressful events have an important role in determining acute exacerbation of chronic
A total of 53 cases of primary headache have been registered among the first accesses to the Advanced Medical Presidiums (AMPs) triage managed by the personnel of the civil defense and voluntary associations and by physicians from the University of L’Aquila, department of Anesthesiology, Intensive Care and Pain Therapy during the 5-week period from April 7 to May 11, 2009, immediately after the April 6, 2009 earthquake of L’Aquila
Summary
The present observational study was carried out in four AMPs that were present in tent camps included in seven Mixed Operating Centers (MOC) operating in the area of L’Aquila during a 5-week period after the earthquake (from April 7 to May 11, 2009). Demographic parameters, including name, surname, gender, age, physical conditions (based on a two points scale: 1 = self-sufficient, 2 = not self-sufficient) have been registered for each patient. Cardio-respiratory parameters, including blood pressure (BP), heart rate (HR), body temperature [BT (in °C)] and oxygen saturation (SpO2) have been registered. State of consciousness by Glasgow Coma Scale (GCS) and pain intensity during cephalalgic crisis (time zero, T0) by the verbal numerical rating scale (NRS) have been assessed. Neurological examination has been performed at baseline. Associated clinical conditions and previous and/or current therapy have been registered, including allergies, tobacco addiction, alcoholism and drug addiction. Diagnosis of primary or secondary headache was made on the basis of a simple questionnaire (Table 1) and a therapeutic treatment was defined. The early response to treatment was evaluated
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