Predictive Score for Non-traumatic Secondary Headache After an Emergency Call
Predictive Score for Non-traumatic Secondary Headache After an Emergency Call
The study objective was to identify predictive criteria of severe non-traumatic secondary
 headache among the information gathered during telephone interview conducted by the on-call
 regulating physician at the Centre15.
Headache accounted for 1% of outpatient consultations, 2% of hospital emergency department
 visits and, at the French national level, 1% of complaints motivating calls to the
 prehospital emergency medical service units (The French, physician-led Emergency Calls
 Centers , called either "Center 15" or Service d'Aide Médicale d'Urgence [SAMU]). In 2009,
 the French "SAMU-Urgences de France" society proposed a classification and diagnostic tool
 for evaluating the headache patient, which is yet to be validated by a clinical study. Most
 patients with headache spontaneously consulted the emergency department (ED) and only 4 to 5%
 of patients entered ED through ambulance, fire and rescue department, medicalized ambulance
 (SMUR), or police. Patients attending emergency service for unusual sudden headache arriving
 by ambulance had a higher frequency of subarachnoid haemorrhage.

 Headache studies have mainly been conducted in the ED. The Ottawa rule published by Perry et
 al. in 2013 proposed criteria for conducting explorations for subarachnoid hemorrhage (SAH)
 in patients over 15 years of age with severe, non-traumatic headache, having reached maximum
 intensity within one hour.

 Unlike the primary headaches, secondary headaches are associated with underlying causes.
 Among the severe secondary headaches (SSH) (4 to 5% of headaches), non-traumatic subarachnoid
 haemorrhage was not diagnosed in 5.4% to 12% of cases in ED resulting in increase in
 mortality from 5 to 14%.

 In 2018, French guidelines for the emergency management of headache recognized criteria
 likely to be at risk of Severe Secondary Headache, requiring explorations in emergencies for
 sudden headaches or thunderclaps headaches (i.e. reaching maximum intensity in less than a
 minute), recent headaches or progressive worsening (<7 days) and unusual, association with
 fever (apart from an obvious cause), association with signs of neurological impairment,
 suspicion of carbon monoxide poisoning, immunosuppression (neoplasia, HIV). Any unusual
 headache in a patient with recurrent paroxysmal or chronic headache should be considered
 secondary until proven otherwise. Subarachnoid hemorrhages were present in 11% of patients
 with sudden, intense and unusual headache.

 In the French department of Loiret, patients with subarachnoid haemorrhage required a
 transfer out of the department to the nearest regional referral teaching hospital, by lack of
 adequate equipment and expertise for interventional neurology. Early diagnosis was therefore
 critical. In fact, an untreated cerebral aneurysm rupture increased bleeding recurrence by
 3-4% in the first 24 hours.
Inclusion Criteria:

 -  Telephone call from center 15 for the headache pattern

 -  Age ≥ 18

 -  Non-opposition expressed by the patient

 -  Or non-opposition delayed (adults with cognitive disorders, protected adults, clinical
 situations judged to be serious by the Medical Regulation Assistant, physician
 regulator, incoming call flow, call by close or trusted person)

 Exclusion Criteria:

 -  Head trauma < 48 hours

 -  Moribund patient

 -  Non-affiliation to a social security scheme

 -  Opposition to the continuation of the study expressed orally by the patient or by
 return mail within 30 days