Abdulaziz M Alghamdi, Abdulkarim M Alghamdi, Yousof Fahad Allarakia, Arwa S Alghamdi, Abdulaziz S Alrashid, Abdulwhab M Alotaibi, Reem Addas, Ahmed I Lary
{"title":"急诊科的非创伤性头痛：识别临床关联和颅内病变的预测性警告信号。","authors":"Abdulaziz M Alghamdi, Abdulkarim M Alghamdi, Yousof Fahad Allarakia, Arwa S Alghamdi, Abdulaziz S Alrashid, Abdulwhab M Alotaibi, Reem Addas, Ahmed I Lary","doi":"10.5144/0256-4947.2025.50","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although headaches are common, only 3-21% are estimated to be secondary, with their causes ranging from non-alarming to life-threatening conditions.</p><p><strong>Objectives: </strong>Evaluate the associated factors and predictive warning signs of intracranial pathologies in patients presenting with nontraumatic headaches to the emergency document (ED).</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Settings: </strong>Medical center in Jeddah.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Main outcome measures: </strong>The associated factors and predictive warning signs of intracranial pathologies.</p><p><strong>Sample size: </strong>387.</p><p><strong>Results: </strong>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%, <i>P</i><.001), to have compressing or sharp headaches (16.4% vs. 6.2%, P=.003), to have constant headaches (16.4% vs. 7.8%, <i>P</i>=.003), to be on chemo-therapy or radiotherapy (10.5% vs. 2.8%, <i>P</i>=.004), and to be smokers (13.4% vs. 6.2%, <i>P</i>=.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, <i>P</i>=.001), motor deficits, including abnormal reflexes (OR: 2.9, CI: 1.2-6.9, <i>P</i>=.011), personality changes, confusion, memory impairment, drowsiness, slurred speech or loss of consciousness (OR: 2.6, CI: 1.4-5.0, <i>P</i>=.002), and sudden onset of headache (OR: 1.9, CI: 1.0-3.6, <i>P</i>=.046) were predictive of intracranial pathologies.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Limitations: </strong>Single-center study and retrospective design.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":"45 1","pages":"50-61"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810879/pdf/","citationCount":"0","resultStr":"{\"title\":\"Nontraumatic headaches in the emergency department: identifying clinical associations and predictive warning signs of intracranial pathologies.\",\"authors\":\"Abdulaziz M Alghamdi, Abdulkarim M Alghamdi, Yousof Fahad Allarakia, Arwa S Alghamdi, Abdulaziz S Alrashid, Abdulwhab M Alotaibi, Reem Addas, Ahmed I Lary\",\"doi\":\"10.5144/0256-4947.2025.50\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although headaches are common, only 3-21% are estimated to be secondary, with their causes ranging from non-alarming to life-threatening conditions.</p><p><strong>Objectives: </strong>Evaluate the associated factors and predictive warning signs of intracranial pathologies in patients presenting with nontraumatic headaches to the emergency document (ED).</p><p><strong>Design: </strong>Retrospective chart review.</p><p><strong>Settings: </strong>Medical center in Jeddah.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Main outcome measures: </strong>The associated factors and predictive warning signs of intracranial pathologies.</p><p><strong>Sample size: </strong>387.</p><p><strong>Results: </strong>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%, <i>P</i><.001), to have compressing or sharp headaches (16.4% vs. 6.2%, P=.003), to have constant headaches (16.4% vs. 7.8%, <i>P</i>=.003), to be on chemo-therapy or radiotherapy (10.5% vs. 2.8%, <i>P</i>=.004), and to be smokers (13.4% vs. 6.2%, <i>P</i>=.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, <i>P</i>=.001), motor deficits, including abnormal reflexes (OR: 2.9, CI: 1.2-6.9, <i>P</i>=.011), personality changes, confusion, memory impairment, drowsiness, slurred speech or loss of consciousness (OR: 2.6, CI: 1.4-5.0, <i>P</i>=.002), and sudden onset of headache (OR: 1.9, CI: 1.0-3.6, <i>P</i>=.046) were predictive of intracranial pathologies.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Limitations: </strong>Single-center study and retrospective design.</p>\",\"PeriodicalId\":93875,\"journal\":{\"name\":\"Annals of Saudi medicine\",\"volume\":\"45 1\",\"pages\":\"50-61\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810879/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Saudi medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5144/0256-4947.2025.50\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5144/0256-4947.2025.50","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/6 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
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.
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