Clinical presentation and assessment of older patients presenting with headache to emergency departments: A multicentre observational study. (27th September 2021)

• Record Type: Journal Article
• Authors: Beck, Sierra; Kinnear, Frances B.; Maree Kelly, Anne; Chu, Kevin H; Sen Kuan, Win; Keijzers, Gerben; Body, Richard; Karamercan, Mehmet A.; Klim, Sharon; Wijeratne, Tissa; Kamona, Sinan; Graham, Colin A; Roberts, Tom; Horner, Daniel; Laribi, Said
• Other Names: Lunter Catherine investigator.; Facer Rochelle investigator.; Thomson David investigator.; Day Robert investigator.; McDonald Greg investigator.; Jones Sarah investigator.; Cochrane Julian investigator.; Gourley Stephen investigator.; Ross Mark investigator.; Gangathimmaiah Vinay investigator.; Hansen Kim investigator.; Kinnear Frances B investigator.; Keijzers Gerben investigator.; Chu Kevin investigator.; Bowe Paul investigator.; de la Cruz Raymund investigator.; Haustead Daniel investigator.; Moller Jean investigator.; Walker Katie investigator.; Smith Richard D investigator.; Sultana Ron investigator.; Pasco John investigator.; Goldie Neil investigator.; Graudins Andis investigator.; Dwyer Rosamond investigator.; Plunkett George investigator.; Kelly Anne‐Maree investigator.; Mitenko Hugh investigator.; Lovegrove Michael investigator.; Smedley Ben investigator.; Graham Colin A investigator.; Leung Ling Yan investigator.; Kuan Win Sen investigator.; Yau Ying Wei investigator.; Ng Wei Ming investigator.; Kumar Ranjeev investigator.; Chia Dennis Wen Jie investigator.; Laribi Said investigator.; Hilal Mounir investigator.; Mil Rarthtana investigator.; Gerineau Audrey investigator.; Reed Matthew J investigator.; Horner Daniel investigator.; Carlton Edward investigator.; Roberts Tom investigator.; Boggaram Girish investigator.; Foot Jayne investigator.; Appleboam Andy investigator.; Goss Rachel investigator.; Malik Hamza investigator.; Body Richard investigator.; Williamson John‐Paul investigator.; Golea Adela investigator.; Luka Sonia investigator.; Avni Demir Huseyin investigator.; Gülpinar Şafak Öner investigator.; Tolu Lale investigator.; Hacimustafaoğlu Muhammet investigator.; Karamercan Mehmet A investigator.; Çelikel Elif investigator.; Çaltili Çilem investigator.; Gürü Selahattin investigator.; Yavuz Gülşah investigator.; Verschuren Franck investigator.; Ramos Christopher investigator.; Denoel Paule investigator.; Wilmet Nicolas investigator.; Vandoorslaert Michael investigator.; Manara Alessandro investigator.; Higuet Adeline investigator.; Sheffy Amichai investigator.; Kamona Sinan investigator.; Jones Peter investigator.; Nguyen Mai investigator.; Clarke Anne investigator.; Beck Sierra investigator.; Munro Andrew investigator.; Yates Kim M investigator.; Weaver James investigator.; Moore Deborah investigator.; Innes Stuart investigator.; Walters Karina investigator.; Simons Koen investigator.; Kelly Anne‐Maree investigator.; Chu Kevin investigator.; Wijeratne Tissa investigator.; Kinnear Frances B investigator.; Keijzers Gerben investigator.; Kamona Sinan investigator.; Kuan Win Sen investigator.; Graham Colin investigator.; Body Richard investigator.; Laribi Said investigator.; Klim Sharon investigator.; Karamercan Mehmet investigator.; Roberts; Tom investigator.; Kelly Anne‐Maree investigator.; Klim Sharon investigator.; Russell Kerrie investigator.;
• Is Part Of: Australasian journal on ageing. Volume 41:Number 1(2022)
• Page Start: 126
• Page End: 137
• Publication Date: 2021-09-27
• Subjects: aged -- emergency departments -- epidemiology -- headache; Older people -- Periodicals; Older people -- Australia -- Periodicals; Old age -- Periodicals; Geriatrics -- Periodicals; Gerontology -- Pacific Area -- Periodicals; 618.97
• DOI: 10.1111/ajag.12999
• Languages: English
• ISSNs: 1440-6381

Abstract

Abstract: Objective: To describe the characteristics, assessment and management of older emergency department (ED) patients with non‐traumatic headache. Methods: Planned sub‐study of a prospective, multicentre, international, observational study, which included adult patients presenting to ED with non‐traumatic headache. Patients aged ≥75 years were compared to those aged <75 years. Outcomes of interest were epidemiology, investigations, serious headache diagnosis and outcome. Results: A total of 298 patients (7%) in the parent study were aged ≥75 years. Older patients were less likely to report severe headache pain or subjective fever (both P < 0.001 ). On examination, older patients were more likely to be confused, have lower Glasgow Coma Scores and to have new neurological deficits (all P < 0.001). Serious secondary headache disorder (composite of headache due to subarachnoid haemorrhage (SAH), intracranial haemorrhage, meningitis, encephalitis, cerebral abscess, neoplasm, hydrocephalus, vascular dissection, stroke, hypertensive crisis, temporal arteritis, idiopathic intracranial hypertension or ventriculoperitoneal shunt complications) was diagnosed in 18% of older patients compared to 6% of younger patients ( P < 0.001). Computed tomography brain imaging was performed in 66% of patients ≥75 years compared to 35% of younger patients ( P < 0.001). Older patients were less likely to be discharged (43% vs 63%, P < 0.001). Conclusions: Older patients with headache had different clinical features to the younger cohort and were more likely to have a serious secondary cause of headache than younger adults. There should be a low threshold for investigation in older patients attending ED with non‐traumatic headache.