Meaning of Headache at the Emergency Department

Abstract

AIM: We investigated the meaning of headache in the emergency room, as a precursor symptom of structural or systemic disorders, especially life-threatening neurological disorders, or as one of the other headaches unrelated to structural disorders in patients who applied to the emergency department with headache complaints. The causes of primary and secondary headaches should be carefully differentiated from each other at the emergency situations. METHODS: Patients aged 18 years and older, who applied to the Emergency Department of the Faculty of Medicine of 19 Mayis University, with a complaint of headache were included in the study. Primary headaches were divided into subtypes according to the IHS (International Headache Society) classification. Secondary headaches were divided into two subgroups as neurological and nonneurological. RESULTS: 200 patients, 112 women and 88 men, who applied to the emergency department with the complaint of headache, were included in the study. Migraine was found in 48 patients, tension-type headache in 29 patients, cerebrovascular disease in 52 patients, CNS infection in 4 patients, intracranial mass in 11 patients, traumatic bleeding in 6 patients, psychiatric disorders in 8 patients, sinusitis in 9 patients, and metabolic disease in 22 patients. Cranial CT was normal in 10 patients with primary headache, cerebral hemorrhage in one patient and cerebral edema was found in one patient. Cranial CT was normal in 18 patients with secondary headache, SAH in 40 patients, intracerebral hemorrhage in 4 patients, intracranial mass in 10 patients, subdural hematoma in 4 patients, cerebral edema and ischemia in 6 patients, and epidural hematoma were found in 1 patient. CONCLUSION: The causes of patients presenting to the emergency department with headache were cerebrovascular disease, migraine, and tension-type headache. In our study, the most common cause was cerebrovascular disease. The prevalence of migraine varies between 3.4-6.1% in men and 12.9-17.7% in women. In our study, the incidence of migraine was 23%, and it was seen 3 times more in women than in men.