Abstract
Headache is a common reason to visit the emergency department (ED). Tension-type headache (TTH) is the commonest headache. The diagnosis of TTH implies a mild condition, with no need for special tests. We evaluated the use of the International Classification of Headache Disorders (ICHD) criteria for TTH in the ED. We performed a cross-sectional study including all ED patients with a definite TTH diagnosis in their discharge report for 2.5 years. We evaluated whether the ICHD criteria for TTH were referenced and met. We analysed discrepancies concerning anamnesis or prior history and reclassified patients. A total of 211 out of 2132 patients fulfilled the criteria (9.9%). Only five patients fulfilled TTH criteria. Criteria A-D were referenced in 60–84% of patients and met in 16–74% of these patients. Anamnesis was discrepant in 87.5% as was prior history in 20.8%. After re-reclassification, 21 patients fulfilled the criteria for TTH (five) or probable TTH (16). In 106 patients, another headache was diagnosed, with migraine in 40 (18.9%), secondary headache in 64 (30.3%), and a life-threatening disorder in 13 (6.1%). In our sample, TTH was overdiagnosed. Only a minority of patients fulfilled the ICHD criteria. Inconsistencies in prior medical history or anamnesis were frequent.
Highlights
Tension-type headache (TTH) is the most common primary headache disorder[1,2]
We hypothesize that TTH is probably overdiagnosed in the emergency department (ED) setting, which might represent a risk for patients with nondetected secondary headaches
The frequencies at which each criterion was referenced were as follows: criterion A was referenced in 81% of patients and fulfilled in 16% of patients, criterion B was referenced in 84% of patients and fulfilled in 74% of patients, criterion C was mentioned in 72% of patients and fulfilled in 43% of patients, and criterion D was referenced in 60% of patients and fulfilled in 56% of patients
Summary
Tension-type headache (TTH) is the most common primary headache disorder[1,2]. The prevalence of TTH is estimated to be between 30 and 70% of the general population according to different studies[2]. Given the mild nature of the disorder, few patients seek assistance, and in headache unit-based series, it is not a frequent diagnosis, accounting for 16% of all diagnoses[7]. It seems remarkable that in some ED-based series, TTH diagnosis accounts for up to 25–33% of all headache visits;[9,10] when other series are performed by neurologists or using ICHD criteria diagnosis, TTH represents only 1–6% of total headache patients[11,12,13,14,15]. We hypothesize that TTH is probably overdiagnosed in the ED setting, which might represent a risk for patients with nondetected secondary headaches. The third objective was to analyse whether patients could be re-classified as having other headache disorders by using the ICHD-3 criteria. Not aggravated by routine physical activity, such as walking or climbing stairs Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia Not better accounted for by another ICHD-3 diagnosis
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