Understanding the Care for Headache in Emergency Departments: Anne-Maree Kelly, MD


The director of the Joseph Epstein Center for Emergency Medicine Research discussed the origin behind her multinational study evaluating the outcome of headache in emergency departments. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"We found wildly varying rates of advancing imaging, particularly CT scanning, ranging from about 1 in 4 patients to about 3 in every 4 patients, and that variation appears to be geographical. Just as a sideline, we’ve done more analyses and it seems to not correlate well with positive findings."

Although headache is a common reason for presentation to emergency departments (ED), questions remain about the epidemiology, investigation, and treatment of those with nontraumatic headache as the main presenting complaint. To better describe this epidemiology, an international, multicenter, cross-sectional study led by Anne-Maree Kelly, MD, included 4536 patients across 67 hospitals and 10 countries and was conducted over 1 calendar month in 2019.

Head trauma, interhospital transfers, re-presentation with same headache as a recent visit, and headache as an associated symptom were all excluded from the analysis, while clinicians collected other data on demographics, clinical assessment, investigation, treatment, and outcome. The results showed an array of different diagnoses made and wide variation in the use of neuroimaging and treatments, which highlighted the challenges of treating headache in this setting.

Kelly, senior emergency physician, Western Health, and director, Joseph Epstein Center for Emergency Medicine Research, sat down with NeurologyLive® to discuss the motivation behind the large analysis, as well as the top findings she observed. She also provided context on why previous research on dyspnea played a role in the reasoning for the study, and how studies like this are great self-assessments of our medical institutions.

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