Author Spence J
Institution Department of Medicine, University of Toronto, and St. Michael's Hospital, Ontario, Canada.
Title Migraine and other causes of headache.
Source Ann Emerg Med 1996 Apr;27(4): p448-50
ISSN 0196-0644
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on |  |
Title Classification and diagnostic criteria for headache disorders, cranial neuralgia, and facial pain.
Source Cephalgia 8(Suppl 7):1, 1988
3.
Unique Identifier 95357280
Author
Perkins AT; Ondo W
Institution
Department of Medicine, Duke University Medical Center, Durham, North
Carolina, USA.
Title When to worry
about headache. Head pain as a clue to intracranial disease.
Source
Postgrad Med 1995 Aug;98(2): p197-201, 204-8
ISSN
0032-5481
Abstract
Careful evaluation of headache is important to detect potentially morbid but treatable causes. Although such causes represent only 10% of all emergency department visits for headache, the consequences of a missed diagnosis can be severe. Unfortunately, the cost of performing computed tomography or magnetic resonance imaging for every patient with headache is prohibitive. However, familiarity with the differential diagnostic considerations, together with a high of suspicion, should allow physicians to perform efficient, cost-effective examinations of all patients who seek treatment for headache.
4. Unique Identifier 95081527
Author
Thomas SH; Stone CK
Institution
Department of Emergency Medicine, East Carolina University School of
Medicine, Greenville, NC 27858-4354.
Title
Emergency department treatment of migraine, tension, and mixed-type headache
[see comments]
Source J Emerg Med
1994 Sep-Oct;12(5): p657-64
ISSN 0736-4679
Abstract
5. Unique Identifier 79088237The complaint of headache is frequently encountered in the emergency department, but most patients with cephalalgia have a benign etiology for their pain. At least 90% of patients presenting with headache are diagnosed as suffering from benign vascular or muscle-tension (for example, migraine, tension, or mixed-type) headache. There is no consensus on the ideal therapeutic approach to these patients. Classically utilized narcotic therapy suffers from problems with efficacy, relapse, and potential for abuse and addiction. However, other agents have successively proved to be imperfect as well, despite the many therapeutic approaches that have been suggested in the medical literature. While no one drug has emerged as clearly superior for treatment of acute benign headache, recent investigations have clarified the role of certain therapies. This review is intended to familiarize emergency physicians with the latest information on most recommended therapeutic approaches to the patient with headache.
Author Dhopesh V; Anwar R; Herring C
Title A retrospective assessment of emergency department patients with complaint of headache.
Source Headache 1979 Jan;19(1): p37-42
ISSN 0017-8748
6. Personal Injury News Volume 2 Issue 8 Bacterial Meningitis
7.Unique Identifier 93182804
Author Karcz A; Holbrook J; Burke MC;
Doyle MJ; Erdos MS; Friedman M; Green ED; Iseke RJ; Josephson GW; Williams K
Institution Department of Emergency
Medicine, Metrowest Medical Center, Framingham, Massachusetts.
Title
Massachusetts emergency medicine closed malpractice claims: 1988-1990.
Source Ann Emerg Med 1993 Mar;22(3):
p553-9
ISSN 0196-0644
Abstract
STUDY PURPOSE: To describe the characteristics of malpractice claims against emergency physicians and to identify causes and potential preventability of such claims. POPULATION: Malpractice claims closed in 1988, 1989, and 1990 against emergency physicians insured by the Massachusetts Joint Underwriters Association were compared with claims closed from 1980 to 1987 as investigated in our previous study. METHODS: Retrospective review of malpractice claim files by board-certified emergency physicians. RESULTS: The average indemnity and expense per claim were higher in the current study population than in our previous study population (P = .05). Claims in eight high-risk diagnostic areas (chest pain, abdominal pain, fractures, wounds, pediatric fever/meningitis, subarachnoid hemorrhage, aortic aneurysm, and epiglottitis) accounted for 50.8% of claims in this study and 55.5% of total monetary losses. Four claims in this study were related to two instances of failure of an emergency department radiograph follow-up system. The evaluation of patients who were intoxicated contributed to major monetary losses, especially in cases of fractures and head injury. CONCLUSION: Emergency physicians must have a particular awareness of their great risk exposure for missed myocardial infarction. Addition of dictation or voice-activated record generation systems, departmental protocols for radiograph follow-ups, and holding and re-evaluation of the intoxicated patient will help provide systems supports for reducing the liability of individual emergency physicians.
8. Unique Identifier 96331133
Author
Karcz A; Korn R; Burke MC; Caggiano R; Doyle MJ; Erdos MJ; Green ED;
Williams K
Institution Healthcare
Opportunities, Inc. Watertown, MA, USA.
Title
Malpractice claims against emergency physicians in Massachusetts: 1975-1993.
Source Am J Emerg Med 1996 Jul;14(4):
p341-5
ISSN 0735-6757
Abstract
This study reviewed 549 malpractice claims filed against emergency physicians in Massachusetts from 1975 through 1993, with a total of $39,168,891 of indemnity and expense spent on the 549 closed claims. High-risk diagnostic categories (chest pain, abdominal pain, wounds, fractures, pediatric fever/meningitis, epiglottitis, central nervous system bleeding, and abdominal aortic aneurysm) accounted for 63.75% of all closed claims and 64.23% of the total indemnity and expense spent on closed claims. Missed myocardial infarction (chest pain) claims accounted for 25.47% of the total cost of closed claims but only 10.38% of closed claims. The number of claims for missed myocardial infarction increased in the post-1988 closed claim group compared to the pre-1988 group; fractures and wounds were significantly less frequent in the post-1988 group. The frequency of high-risk claims decreased in the post-1988 group, largely because of the decline in fracture and wound claims. The category of missed myocardial infarction had a larger percentage of claims closed with indemnity payment than without indemnity payment. This parameter may serve as a marker for the overall seriousness of claims associated with a particular allegation, unlike the average cost per claim, which may be skewed by a few large awards.
9. Unique Identifier
98205045
Author Newman LC; Lipton
RB
Institution Department of Neurology,
Albert Einstein College of Medicine, Montefiore Headache Unit, Bronx, New York,
USA.
Title Emergency department
evaluation of headache.
Source Neurol
Clin 1998 May;16(2): p285-303
ISSN 0733-8619
Abstract
Headache is an extremely common complaint in the Emergency Department, accounting for up to 16% of all visits. Although there are more than 300 medical conditions which can produce headache, the vast majority of headache disorders are benign. This article outlines an orderly approach for evaluating patients who present with headaches; in addition, the authors discuss the emergency treatment of the more common types of headache.
10. Unique
Identifier 96236306
Author Evans
RW
Institution Department of Neurology,
University of Texas, Houston Medical School, USA.
Title
Diagnostic testing for the evaluation of headaches.
Source
Neurol Clin 1996 Feb;14(1): p1-26
ISSN
0733-8619
Abstract
Headaches are one of the most common symptoms that neurologists evaluate. Although most are caused by primary disorders, the list differential diagnoses is one of the longest in all of medicine, with over 300 different types and causes. The cause or type of most headaches can be determined by a careful history supplemented by a general and neurologic examination. Reasons for obtaining neuroimaging include medical indications as well as anxiety of patients and families and medico-legal concerns. In the era of managed care, concerns over deselection and negative capitation may dissuade the physician from ordering even a medically indicated scan. The yield of neuroimaging in the evaluation of patients with headache and a normal neurologic examination is quite low. Combining the results of multiple studies performed since 1977 for a total of 3026 scans reveals the overall percentages of various pathologies as: brain tumors, 0.8%; arteriovenous malformations, 0.2%; hydrocephalus, 0.3%; aneurysm, 0.1%; subdural hematoma, 0.2%; and strokes, including chronic ischemic processes, 1.2%. EEG is not useful in the routine evaluation of patients with headache. Similarly, the yield of neuroimaging in the evaluation of migraine is quite low. Combining the results of multiple studies performed since 1976 for a total of 1440 scans of patients with various types of migraine, the overall percentages of various pathologies are: brain tumor, 0.3%; arteriovenous malformation, 0.07%; and saccular aneurysm, 0.07%. WMA have been reported on MRI studies of patients with all types of migraine, with a range from 12% to 46%. The cause of WMA in migraine is not certain. Cerebral atrophy has been variable reported as more frequent and no more frequent in migraineurs compared with controls. The "first or worst" headache has a long list of possible causes and always includes the possibility of acute subarachnoid hemorrhage. Headaches--especially the sentinel type caused by SAH--often are misdiagnosed. The probability of detecting an aneurysmal hemorrhage of CT scans performed at various intervals after the ictus is: day 0.95%; day 3, 74%; 1 week, 50%; 2 weeks, 30%; and 3 weeks, almost nil. The location of a ruptured saccular aneurysm often is suggested by the predominant site of the SAH. The probability of detecting xanthochromia with spectrophotometry in the CSF at various times after a subarachnoid hemorrhage is: 12 hours, 100%; 1 week, 100%; 2 weeks, 100%; 3 weeks, more than 70%; and 4 weeks, more than 40%. The management of thunderclap headaches with normal CT scan and CSF examinations is controversial. Most patients have a benign course but an unruptured saccular aneurysm occasionally may be responsible for the headache. MR angiography may be a reasonable test to obtain instead of a cerebral arteriogram in many of these cases. About 30% to 90% of patients have headaches of various types and causes after mild head injury. Although most headaches are relatively benign, perhaps 1% to 3% of these patients have life-threatening pathology, including subdural and epidural hematomas, that are detected on CT and MRI scans. Headaches caused by subdural hematomas can be nonspecific. When new-onset headaches begin in patients over the age of 50 years, the physician always should consider whether it may be a secondary headache disorder requiring specific diagnostic testing and treatment. Up to 15% of patients 65 years and over who present to neurologists with new-onset headaches may have serious pathology such as stroke, TA, neoplasm, and subdural hematoma. Headaches are the most common symptom of TA, reported by 60% to 90%. The only over the temple. The diagnosis of TA is based on a high of clinical suspicion that usually but not always is confirmed by laboratory testing. The erythrocyte sedimentation rate can be normal in 10% to 36% of patients with TA. A superficial temporal artery biopsy can give a false-negative result in 5% to 44% of patients.
11. Unique
Identifier 99106412
Author Sztajnkrycer
M; Jauch EC
Institution Department
of Emergency Medicine, University of Cincinnati Medical Center, Ohio, USA.
Title Unusual headaches.
Source
Emerg Med Clin North Am 1998 Nov;16(4): p741-60, vi
ISSN
0733-8627
Abstract
Headache represents one of the most common somatic complaints seen in the emergency department, accounting for 1% to 3% of all emergency department visits. Although most headaches seen in the emergency department are benign, as many as 10% of all headaches are secondary to an underlying pathologic condition. The emergency physician is well-trained to exclude stoke, subarachnoid hemorrhage, and meningitis as potential causes of headache. This article focuses on seven unusual headache syndromes, all of which are associated with significant morbidity and mortality. Particular emphasis is placed on clinical features and diagnostic modalities of choice.
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