Nontraumatic headaches in the emergency department: identifying clinical associations and predictive warning signs of intracranial pathologies

BACKGROUND:
Although headaches are common, only 3–21% are estimated to be secondary, with their causes ranging from non-alarming to life-threatening conditions.


OBJECTIVES:
Evaluate the associated factors and predictive warning signs of intracranial pathologies in patients presenting with nontraumatic headaches to the emergency document (ED).


DESIGN:
Retrospective chart review


SETTINGS:
Medical center in Jeddah


PATIENTS AND METHODS:
Data were collected from all patients who presented to the ED with nontraumatic headaches and underwent brain computed tomography (CT) scans from September 2021 to September 2022.


MAIN OUTCOME MEASURES:
The associated factors and predictive warning signs of intracranial pathologies.


SAMPLE SIZE:
387


RESULTS:

Sixty-seven (17.31%) patients had intracranial pathologies. The median (IQR) age of all patients was 49 (23) years and females constituted 61.8%. Patients with intracranial pathologies were significantly more likely to have severe headaches (59.7% vs. 33.7%,
P
<.001), to have compressing or sharp headaches (16.4% vs. 6.2%, P=.003), to have constant headaches (16.4% vs. 7.8%,
P
=.003), to be on chemo-therapy or radiotherapy (10.5% vs. 2.8%,
P
=.004), and to be smokers (13.4% vs. 6.2%,
P
=.042) than the other group. Multiple logistic regression of headache warning signs revealed that significant changes or progression in pattern, frequency, or severity of headache (OR: 3.2, CI: 1.5–6.6,
P
=.001), motor deficits, including abnormal reflexes (OR: 2.9, CI: 1.2–6.9,
P
=.011), personality changes, confusion, memory impairment, drowsiness, slurred speech or loss of consciousness (OR: 2.6, CI: 1.4–5.0,
P
=.002), and sudden onset of headache (OR: 1.9, CI: 1.0–3.6,
P
=.046) were predictive of intracranial pathologies.



CONCLUSIONS:
Our findings suggest that these four headache warning signs can help physicians predict intracranial pathologies and subsequently decide which patients should undergo brain imaging in non-traumatic headache cases.


LIMITATIONS:
Single-center study and retrospective design