{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:17:24Z","timestamp":1792631844976,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T00:00:00Z","timestamp":1726531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Purpose<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A narrative literature review was conducted via a MEDLINE search in October 2021. The \u201cCode Headache\u201d 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 \u2018PEACE\u2019) to guide the selection of complementary tests and aid diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16484","type":"journal-article","created":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T14:39:53Z","timestamp":1726583993000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["\u201cCode Headache\u201d: Development of a protocol for optimizing headache management in the emergency room"],"prefix":"10.1111","volume":"31","author":[{"given":"Javier A.","family":"Membrilla","sequence":"first","affiliation":[{"name":"Department of Neurology Hospital Universitari Francesc de Borja  Gand\u00eda Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Alpuente","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Universitari Vall d'Hebron  Barcelona Spain"},{"name":"Department of Medicine, Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"},{"name":"Department of Neurology, Headache Clinic Vall d'Hebron University Hospital  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"G\u00f3mez\u2010Dabo","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Universitari Vall d'Hebron  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garc\u00eda\u2010Yu","family":"Ra\u00fal","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Universitario La Paz  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Mari\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Universitario La Paz  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"D\u00edaz\u2010de\u2010Ter\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Universitario La Paz  Madrid Spain"},{"name":"Hospital La Paz Institute for Health Research \u2010 IdiPAZ (La Paz University Hospital, Universidad Aut\u00f3noma de Madrid \u2010 Getafe Universitary Hospital \u2010 Universidad Europea de Madrid)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Pozo\u2010Rosich","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Universitari Vall d'Hebron  Barcelona Spain"},{"name":"Department of Medicine, Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"},{"name":"Department of Neurology, Headache Clinic Vall d'Hebron University Hospital  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nrl.2021.03.015"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10194-009-0178-3"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2016.06.003"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-019-1053-5"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14230"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nrl.2020.06.019"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ienj.2014.06.001"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006697"},{"issue":"1","key":"e_1_2_10_10_1","first-page":"21","article-title":"Ability to predict hospitalization and resource requirements: comparison of the 3M triage assistance system and the combined Spanish triage system and Andorran triage model","volume":"28","author":"S\u00e1nchez Bermejo R","year":"2016","journal-title":"Emergencias"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42466-020-00098-6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000010618"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11936-013-0236-7"},{"key":"e_1_2_10_14_1","unstructured":"GECSEN.Gu\u00eda Pr\u00e1ctica Diagn\u00f3stico Terap\u00e9utica de La Cefalea Del Adulto y El Ni\u00f1o En Urgencias.2016."},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13744"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurol.2016.06.005"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2012.06028.x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ienj.2013.03.009"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.enfie.2018.01.001"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S266087"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024221120249"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14054"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-021-00995-8"},{"key":"e_1_2_10_24_1","unstructured":"Ministerio de Sanidad SS e I.Real Decreto 954\/2015 de 23 de Octubre Por El Que Se Regula La Indicaci\u00f3n Uso y Autorizaci\u00f3n de Dispensaci\u00f3n de Medicamentos y Productos Sanitarios de Uso Humano Por Parte de Los Enfermeros.2015."},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-46015-2"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.7.866"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/NRL.0b013e3181d14185"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13708"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.16484","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T04:45:15Z","timestamp":1757565915000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.16484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,17]]},"references-count":28,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1111\/ene.16484"],"URL":"https:\/\/doi.org\/10.1111\/ene.16484","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,17]]},"assertion":[{"value":"2024-05-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e16484"}}