Tension-type headache in the Emergency Department Diagnosis and misdiagnosis: The TEDDi study

Headache is a common reason to visit the emergency department (ED). Tension-type headache (TTH) is the commonest headache. The diagnosis of TTH implies a mild condition, with no need for special tests. We evaluated the use of the International Classification of Headache Disorders (ICHD) criteria for...

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Bibliographic Details
Published in:Scientific reports Vol. 10; no. 1; p. 2446
Main Authors: García-Azorín, D., Farid-Zahran, M., Gutiérrez-Sánchez, M., González-García, M. N., Guerrero, A. L., Porta-Etessam, J.
Format: Journal Article
Language:English
Published: London Nature Publishing Group UK 12.02.2020
Nature Publishing Group
Subjects:
692/308/174
692/617/375/226
692/700/139
Adult
Cross-Sectional Studies
Diagnosis
Diagnostic Errors
Emergency medical care
Emergency medical services
Emergency Service, Hospital
Female
Headache
Headaches
Humanities and Social Sciences
Humans
International Classification of Diseases
Male
Middle Aged
Migraine
multidisciplinary
Reclassification
Science
Science (multidisciplinary)
Tension-Type Headache - diagnosis
ISSN:2045-2322, 2045-2322
Online Access:Get full text
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Summary:Headache is a common reason to visit the emergency department (ED). Tension-type headache (TTH) is the commonest headache. The diagnosis of TTH implies a mild condition, with no need for special tests. We evaluated the use of the International Classification of Headache Disorders (ICHD) criteria for TTH in the ED. We performed a cross-sectional study including all ED patients with a definite TTH diagnosis in their discharge report for 2.5 years. We evaluated whether the ICHD criteria for TTH were referenced and met. We analysed discrepancies concerning anamnesis or prior history and reclassified patients. A total of 211 out of 2132 patients fulfilled the criteria (9.9%). Only five patients fulfilled TTH criteria. Criteria A-D were referenced in 60–84% of patients and met in 16–74% of these patients. Anamnesis was discrepant in 87.5% as was prior history in 20.8%. After re-reclassification, 21 patients fulfilled the criteria for TTH (five) or probable TTH (16). In 106 patients, another headache was diagnosed, with migraine in 40 (18.9%), secondary headache in 64 (30.3%), and a life-threatening disorder in 13 (6.1%). In our sample, TTH was overdiagnosed. Only a minority of patients fulfilled the ICHD criteria. Inconsistencies in prior medical history or anamnesis were frequent.
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ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-020-59171-4