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

Abstract

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.