"Code Headache" : Development of a protocol for optimizing headache management in the emergency room
Membrilla, Javier A. (Hospital Universitari Francesc de Borja)
Alpuente, Alicia (Vall d'Hebron Institut de Recerca (VHIR))
Gómez-Dabó, Laura (Hospital Universitari Vall d'Hebron)
Raúl, García-Yu (Hospital Universitario La Paz (Madrid))
Mariño, Eduardo (Hospital Universitario La Paz (Madrid))
Díaz de Terán, Javier (Hospital Universitario La Paz (Madrid))
Pozo-Rosich, Patricia (Universitat Autònoma de Barcelona. Departament de Medicina)

Data:	2024
Resum:	Patients presenting at the emergency room (ER) with headache often encounter a hostile atmosphere and experience delays in diagnosis and treatment. The aim of this study was to design a protocol for the ER with the goal of optimizing the care of patients with urgent headache to facilitate diagnosis and expedite treatment. A narrative literature review was conducted via a MEDLINE search in October 2021. The "Code Headache" protocol was then developed considering the available characteristics and resources of the ER at a tertiary care center within the Spanish National Public Health system. The Code Headache protocol comprises three assessments: two scales and one checklist. The assessments identify known red flags and stratify patients based on suspected primary/secondary headaches and the need for pain treatment. Initial assessments, performed by the triage nurse, aim to first exclude potentially high morbidity and mortality etiologies (HEAD1 scale) and then expedite appropriate pain management (HEAD2 scale) based on scoring criteria. HEAD1 evaluates vital signs and symptoms of secondary serious headache disorders that can most benefit from earlier identification and treatment, while HEAD2 assesses symptoms indicative of status migrainosus, pain intensity, and vital signs. Subsequently, ER physicians employ a third assessment that reviews red flags for secondary headaches (grouped under the acronym 'PEACE') to guide the selection of complementary tests and aid diagnosis. The Code Headache protocol is a much needed tool to facilitate quick clinical assessment and improve patient care in the ER. Further validation through comparison with standard clinical practice is warranted.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Emergency department ; Emergency room ; Headache ; Migraine ; Red flags ; Secondary headache ; Status migrainosus
Publicat a:	European Journal of Neurology, Vol. 31 Núm. 12 (September 2024) , ISSN 1468-1331

DOI: 10.1111/ene.16484
PMID: 39287050

7 p, 618.1 KB

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