{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:23:23Z","timestamp":1760149403993,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T00:00:00Z","timestamp":1689897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: There is scarce data about the epidemiology, clinical features, investigations, diagnosis, treatment, and outcome in patients attending Singapore emergency departments (EDs) with nontraumatic headache. We sought to describe these characteristics of adult patients presenting to the ED with a primary complaint of headache. Materials and Methods: We performed a cross-sectional study on adult patients with nontraumatic headache over 4 consecutive weeks from 18 March 2019 to 14 April 2019 across four EDs in Singapore. Exclusion criteria were history of head trauma within 48 h of presentation, missing records, interhospital transfers, representation with the same headache as a recent previous visit and headache as an associated symptom. Results: During the study period, 579 patients (representing 1.8% of the total ED census) comprising 55.3% males and with a median age of 36 years presented to the four Singapore EDs with a primary complaint of nontraumatic headache. Paracetamol (41.5%), non-steroidal anti-inflammatory drugs (34.4%) and tramadol (31.5%) were the three commonest analgesics used either singly or in combination. Prochlorperazine (22.9%) and metoclopramide (17.4%) were frequent anti-emetic adjuncts. One-third of patients had computed tomography of the brain performed, which found abnormalities among 20.9% of them. ED diagnoses of primary headache conditions were made in 73.6% of patients. Conclusions: Primary headaches constituted most ED headache diagnoses. ED imaging of selected patients yielded a relatively high pick-up rate for significant intracranial abnormalities. Opioid use for symptomatic relief of headaches in the ED was found to be high, underscoring the need for improvement in headache analgesia relief practices in the ED.<\/jats:p>","DOI":"10.3390\/medicina59071340","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T00:57:30Z","timestamp":1690160250000},"page":"1340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Headache in the Emergency Department: A Multicenter Observational Study from Singapore"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2134-7842","authenticated-orcid":false,"given":"Win Sen","family":"Kuan","sequence":"first","affiliation":[{"name":"Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjeev","family":"Kumar","sequence":"additional","affiliation":[{"name":"Acute & Emergency Care Centre, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying Wei","family":"Yau","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei Ming","family":"Ng","sequence":"additional","affiliation":[{"name":"Emergency Department, Ng Teng Fong General Hospital, National University Health System, Singapore 609606, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis Wen Jie","family":"Chia","sequence":"additional","affiliation":[{"name":"Emergency Department, Sengkang General Hospital, Singapore Health Services, Singapore 544886, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ee Yang","family":"Ng","sequence":"additional","affiliation":[{"name":"Acute & Emergency Care Centre, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanwar Sudhir","family":"Lather","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mui Teng","family":"Chua","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s10194-022-01402-2","article-title":"The global prevalence of headache: An update, with analysis of the influences of methodological factors on prevalence estimates","volume":"23","author":"Stovner","year":"2022","journal-title":"J. Headache Pain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/head.14024","article-title":"The prevalence and impact of migraine and severe headache in the United States: Updated age, sex, and socioeconomic-specific estimates from government health surveys","volume":"61","author":"Burch","year":"2021","journal-title":"Headache"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1046\/j.0333-1024.2002.00272.x","article-title":"A community-based study of headache diagnosis and prevalence in Singapore","volume":"23","author":"Ho","year":"2003","journal-title":"Cephalalgia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.47102\/annals-acadmedsg.V38N11p1007","article-title":"Emergency department headache admissions in an acute care hospital:why do they occur and what can we do about it?","volume":"38","author":"Ang","year":"2009","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.emc.2020.09.004","article-title":"Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes, An Update","volume":"39","author":"Raam","year":"2021","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Headache, Godwin, S.A., Cherkas, D.S., Panagos, P.D., Shih, R.D., Byyny, R., and Wolf, S.J. (2019). Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Ann. Emerg. Med., 74, e41\u2013e74.","DOI":"10.1016\/S0196-0644(19)31168-0"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1177\/0333102414535997","article-title":"Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings","volume":"35","author":"Orr","year":"2015","journal-title":"Cephalalgia"},{"key":"ref_8","unstructured":"Ferguson, C. (2023, June 21). College of Emergency Medicine. Guideline for the Management of Lone Acute Severe Headache. Available online: https:\/\/rcem.ac.uk\/wp-content\/uploads\/2021\/10\/Lone_Acute_Severe_Headache_Flowchart_Dec2009.pdf."},{"key":"ref_9","unstructured":"National Institute for Heath and Care Excellence Guideline (2023, June 21). Headaches in Over 12s: Diagnosis and Management. Available online: https:\/\/www.nice.org.uk\/guidance\/cg150."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1067\/mem.2003.24","article-title":"Variations among emergency departments in the treatment of benign headache","volume":"41","author":"Vinson","year":"2003","journal-title":"Ann. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1111\/head.13110","article-title":"Medical Undergraduate Survey on Headache Education in Singapore: Knowledge, Perceptions, and Assessment of Unmet Needs","volume":"57","author":"Ong","year":"2017","journal-title":"Headache"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1111\/head.14230","article-title":"Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)-A multinational observational study","volume":"61","author":"Kelly","year":"2021","journal-title":"Headache"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J. Biomed. Inform."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1111\/j.1468-2982.2006.01093.x","article-title":"Headache in United States emergency departments: Demographics, work-up and frequency of pathological diagnoses","volume":"26","author":"Goldstein","year":"2006","journal-title":"Cephalalgia"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/acem.13062","article-title":"Acute Headache Presentations to the Emergency Department: A Statewide Cross-sectional Study","volume":"24","author":"Chu","year":"2017","journal-title":"Acad. Emerg. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s10194-019-1053-5","article-title":"Headaches in the emergency department -a survey of patients\u2019 characteristics, facts and needs","volume":"20","author":"Doretti","year":"2019","journal-title":"J. Headache Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"75","DOI":"10.11622\/smedj.2019041","article-title":"Factors associated with inappropriate attendances at the emergency department of a tertiary hospital in Singapore","volume":"61","author":"Oh","year":"2020","journal-title":"Singapore Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"818","DOI":"10.47102\/annals-acadmedsg.2021151","article-title":"Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study","volume":"50","author":"Cheng","year":"2021","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1212\/01.wnl.0000252808.97649.21","article-title":"Migraine prevalence, disease burden, and the need for preventive therapy","volume":"68","author":"Lipton","year":"2007","journal-title":"Neurology"},{"key":"ref_20","unstructured":"(2023, June 21). Population in Brief 2019, Available online: https:\/\/www.population.gov.sg\/files\/media-centre\/publications\/population-in-brief-2019.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s10194-018-0899-2","article-title":"Aids to management of headache disorders in primary care (2nd edition): On behalf of the European Headache Federation and Lifting The Burden: The Global Campaign against Headache","volume":"20","author":"Steiner","year":"2019","journal-title":"J. Headache Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S1474-4422(04)00824-5","article-title":"Medication-overuse headache: A worldwide problem","volume":"3","author":"Diener","year":"2004","journal-title":"Lancet Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1212\/WNL.0000000000004642","article-title":"Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine","volume":"89","author":"Friedman","year":"2017","journal-title":"Neurology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"399","DOI":"10.11622\/smedj.2018094","article-title":"The adult patient with headache","volume":"59","author":"Lee","year":"2018","journal-title":"Singapore Med. J."},{"key":"ref_25","unstructured":"(2023, June 21). National Guidelines For The Safe Prescribing Of Opioids (First Edition). Ministry of Health. Singapore, Available online: https:\/\/go.gov.sg\/opioidsguidelines."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s10140-015-1314-9","article-title":"Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis","volume":"22","author":"Quon","year":"2015","journal-title":"Emerg. Radiol."},{"key":"ref_27","first-page":"331","article-title":"Computed tomography imaging in the management of headache in the emergency department: Cost efficacy and policy implications","volume":"101","author":"Jordan","year":"2009","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Handschin, N., Oppliger, M., Brehm, A., Psychogios, M., Bonati, L., Nickel, C.H., and Bingisser, R. (2020). Nontraumatic Headache in Adult Emergency Patients: Prevalence, Etiologies, and Radiological Findings. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082621"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.ajem.2014.05.017","article-title":"The association between headache and elevated blood pressure among patients presenting to an ED","volume":"32","author":"Friedman","year":"2014","journal-title":"Am. J. Emerg. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1093\/ajh\/hpw041","article-title":"The Paradoxical Significance of Headache in Hypertension","volume":"29","author":"Courand","year":"2016","journal-title":"Am. J. Hypertens."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/0333102417738202","article-title":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition","volume":"38","author":"Arnold","year":"2018","journal-title":"Cephalalgia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.annemergmed.2006.11.004","article-title":"Applying the International Classification of Headache Disorders to the emergency department: An assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation","volume":"49","author":"Friedman","year":"2007","journal-title":"Ann. Emerg. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1340\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:16:30Z","timestamp":1760127390000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,21]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["medicina59071340"],"URL":"https:\/\/doi.org\/10.3390\/medicina59071340","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,7,21]]}}}