2025 American Academy of Neurology Abstract Website

Objective:

To determine the predictive factors for serious causes of non-traumatic headache (NTH).

Background:

Non-traumatic headache is a common reason for emergency room visits. However, serious underlying conditions are diagnosed in approximately 10% of cases, potentially leading to significant disability and mortality if not identified and treated promptly.

Design/Methods:

A retrospective analysis of medical records was conducted for emergency room patients with NTH from May to November 2022. Patients were classified into serious and non-serious headache groups, which were compared based on baseline characteristics, associated symptoms and physical examination findings. Regression analysis identified predictive factors for serious NTH causes.

Results:

Out of 7,059 patients, 518 met the inclusion criteria, of which, 47 (9.0%) were diagnosed with a serious headache cause. The factors with a significant predictive value were male sex (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.17-0.75, p=0.01), age >50 years (OR 4.94, 95% CI: 2.28-10.71, p=<0.01), duration of headache >1 week (OR 0.24, 95% CI: 0.01-0.59. p=0.01), seizures (OR 10.57, 95% CI: 1.22-9131, p=<0.03), meningism (OR 50.4, 95% CI: 2.98-853.66, p=<0.01) and neurological deficits, including cranial nerve palsy (OR 5.64, 95% CI: 1.30-24.44, p=<0.21), hemiparesis/plegy (OR 7.13, 95% CI: 2.17-23.48, p=<0.01) and altered consciousness (OR 9.88, 95% CI: 2.93-33.3, p=<0.00).

Conclusions:

The risk factors predictive of serious headache causes align with commonly recognized red flags. Their varying predictive values could form the basis for a risk stratification tool that enhances the accuracy of health workers’ triage of headache patients in the emergency department.