The Need for International Guidelines on Treating Headache in Emergency Departments: Anne-Maree Kelly, MD


The director of the Joseph Epstein Center for Emergency Medicine Research discussed why guidelines developed by international bodies would provide crucial direction for emergency departments in how they treat presenting headache. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"It would be good if all the leaders in all the disciplines actually made themselves available to those bodies and also had a commitment to coming up with consensus rather than being fixed in positions about what they believe is best. A bit of compromise and acceptance that the contexts are different, and that not everybody can have a CT scan within 10 minutes, especially for headache rather than stroke."

Findings from international, observational, cross-sectional study that evaluated the epidemiology of patients presenting with nontraumatic headache to an emergency department (ED) revealed the challenges in diagnosing and managing this group, along with the wide variation in use of neuroimaging and treatments. Across 4536 enrolled patients from 67 hospitals in 10 different countries, more than 30 different diagnoses were made, with presumed nonmigraine benign headache accounting for the most of any cases (45.4%).

Head computed tomography (CT) was performed on 36.6% of patients, of which 9.9% demonstrated clinically important pathology. Between countries, CT scan use ranged from 15.9%-75%. Lead author Anne-Maree Kelly, MD, senior emergency physician, Western Health, and director, Joseph Epstein Center for Emergency Medicine Research, and colleagues concluded that additional work is needed to understand this variation and to better inform international guidelines regarding emergent neuroimaging and treatment.

NeurologyLive® sat down with Kelly to get her thoughts on whether education would be a way to improve the variation across EDs. Although she understood why it might help, she continued to harp on the need to establish international guidelines, as well as which players need to come to the table to make it happen.

Kelly AM, Kuan WS, Chu KH, et al. Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)–a multinational observational study. Headache. 2021;61(10):1539-1552. doi:10.1111/head.14230
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