https://doi.org/10.4081/scenario.2025.597
0
0
0
0
Smart Citations0
0
0
0
Citing PublicationsSupportingMentioningContrasting
See how this article has been cited at scite.ai
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Evaluation of headache by the emergency room nurse. Narrative literature review of the main red-flags and triage models
Introduction: Headache represents a frequent condition in patients who are admitted to the Emergency Room (ER), but the evaluation of symptoms is based on experience and it’s not always done in codified way. The Red-Flags represent the key points to be used in the evaluation of symptoms, but their presence is not always contemplated in the main Triage models.
Materials and methods: A literature review was conducted on 11 databases, aimed at identifying the main Red-Flags relating to headache and their presence in the main Triage models.
Results: From the 19 results included, it emerged that the SNNOOP10 Red-Flags – syncope, convulsions and carbon monoxide exposure – are useful in identifying pathologies secondary to headache. On the other hand, pain, neck stiffness, accentuation of headache, fever and progressive/atypical headache prove to be of unclear usefulness. Blood pressure and blood tests can be helpful in identifying serious causes. Compared to the Triage models, the flow chart of the Triage Training Group is the one that most includes the main Red-Flags identified.
Conclusions: Headache represents a frequent condition in patients who are admitted to the ER and considering the Red-Flags is essential for a correct evaluation of the symptoms.
Keywords: Triage, Headache, Emergency Room, Nurse, Red-Flag
1. W.H.O. Atlas of headache disorders and resources in the world 2011. Lift Burd. 2011;
2. Smitherman TA, Burch R, Sheikh H, Loder E. The Prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from National Surveillance Studies. Headache J Head Face Pain 2013;53:427–36.
3. WHO. Neurological disorders: public health challenges. 2006. 232 p.
4. Negro A, Spuntarelli V, Sciattella P, Martelletti P. Rapid referral for headache management from emergency department to headache centre: four years data. J Headache Pain 2020;21:25.
5. Long BJ, Koyfman A. Benign headache management in the emergency department. J Emerg Med 2018;54:458–68.
6. Rimmele F, Janke J, Kropp P, et al. Headache in the neurological emergency department—high degree of inadequate documentation calls for structured assessments. Front Neurol 2022;13:847484
7. Hervás C, Somovilla A, Gago-Veiga AB, et al. Headache history-taking in an emergency department: impact evaluation of a training session. Pain Med 2021;22:1864–9.
8. García-Azorín D, Abelaira-Freire J, González-García N, et al. Sensitivity of the SNNOOP10 list in the high-risk secondary headache detection. Cephalalgia 2022;42:1521–31.
9. Zhao Y, Lim JX, Wong P. Diagnosis and management of headaches in the emergency department (ED) in adults and children. Neurol India 2021;69:173.
10. Liberman AL, Zhang C, Lipton RB, et al. Short‐term stroke risk after emergency department treat‐and‐release headache visit. Headache J Head Face Pain 2022;62:1198–206.
11. Kelly AM, Kuan W Sen, Chu KH, et al. Epidemiology, investigation, management, and outcome of headache in emergency departments (HEAD study)—A multinational observational study. Headache J Head Face Pain 2021;61:1539–52.
12. Minen M, Zhou K, Lall R, Friedman BW. A retrospective cohort study of urgent care visits and revisits for headache/migraine. Pain Med 2020;21:2458–64.
13. Moraes E Silva M de, Schulze ACB, Cavalheiro BP, et al. Profile and generalist physician knowledge about neurology in emergency department: headache management. Arq Neuropsiquiatr 2020;78:44–9.
14. Mavin C. Does underpinning evidence influence the frequency of neurological observations? Br J Neurosci Nurs 2009;5:456–9.
15. Janice L. Hinkle KHC. Brunner & Suddarth. Infermieristica medico-chirurgica vol.2. 5th ed. Casa Editrice Ambrosiana, Editor. 2017. 992 p.
16. Moura BRS, Oliveira GN, Medeiros G, et al. Rapid triage performed by nurses: Signs and symptoms associated with identifying critically ill patients in the emergency department. Int J Nurs Pract 2022;28:13001
17. Bell SD, Lee C-CT, Zeeman J, et al. Neurological Assessment of the Adult Hospitalized Patient. Am Assoc Neurosci Nurses, 2021.
18. Cortelli P, Cevoli S, Nonino F, et al. Evidence‐based diagnosis of nontraumatic headache in the emergency department: a consensus statement on four clinical scenarios. Headache J Head Face Pain 2004;44:587–95.
19. García-Azorín D, González-García N, Abelaira-Freire J, et al. Management of thunderclap headache in the emergency room: A retrospective cohort study. Cephalalgia 2021;41:711–20.
20. Ramos Lopes J. Headache in the emergency department: which “red flags” predict head CT scan abnormal findings? Sinapse 2021;21:11–8.
21. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice. Neurology 2019;92:134–44.
22. Wongtanasarasin W, Wittayachamnankul B. Clinical availability of SNOOP4 in acute non-traumatic headache patients admitted to the emergency department. Hong Kong J Emerg Med 2022;29:161–7.
23. Blum CA, Winzeler B, Nigro N, et al. Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study. J Headache Pain 2017;18:21.
24. Gruppo Formazione Triage. Triage infermieristico. 4th ed. McGraw-Hill, editor. 2019. 470 p.
25. Manchester Triage Group. Manchester Triage System. 4th ed. Casa Editrice Ambrosiana, editor. Advanced Life Support Group. BMJ Books; 2017. 208 p.
26. Oßwald HM, Harenberg L, Jaschonek H, et al. Development and validation of the Heidelberg Neurological Triage System (HEINTS). J Neurol 2019;266:2685–98.
27. Savoia G, Coluzzi F, Di Maria C, et al. Italian Intersociety Recommendations on pain management in the emergency setting (SIAARTI, SIMEU, SIS 118, AISD, SIARED, SICUT, IRC). Minerva Anestesiol 2015;81:205–25.
28. Wippold FJ, Whealy MA, Kaniecky RG. Evaluation of headache in adults. UpToDate. 2023 [cited 2023 Sep 5]. Available from: https://www.uptodate.com/contents/evaluation-of-headache-in-adults?search=headache&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1294899532
29. Zodda D, Procopio G, Gupta A, et al. Points & Pearls: Evaluation and management of life-threatening headaches in the emergency department. Emerg Med Pract 2019;21:1–2.
30. Perry JJ, Stiell IG, Sivilotti MLA, et al. High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ 2010;341:c5204–c5204.
31. Kaya A, Satar S, Gulen M, et al. Adding eosinophil count to EMERALD rules predicts subarachnoid haemorrhage better in emergency department. Irish J Med Sc 2023;192:1453–62.
32. Locker TE, Thompson C, Rylance J, Mason SM. The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department. Headache J Head Face Pain 2006;46:954–61.
33. Ala A, Rahmani F, Abdollahi S, Parsian Z. Accuracy of neck stiffness, kernig, brudzinski, and jolt accentuation of headache signs in early detection of meningitis. Emerg (Tehran, Iran) 2018;6:e8.
34. Pajor MJ, Long B, Koyfman A, Liang SY. High risk and low prevalence diseases: Adult bacterial meningitis. Am J Emerg Med 2023;65:76–83.
35. Tamune H, Takeya H, Suzuki W, et al. Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults. Am J Emerg Med 2013;31:1601–4.
36. Mac Grory B, Vu L, Cutting S, et al. Distinguishing Characteristics of headache in nontraumatic subarachnoid hemorrhage. Headache J Head Face Pain 2018;58:364–70.
37. Lacy A, Nelson R, Koyfman A, Long B. High risk and low prevalence diseases: Giant cell arteritis. Am J Emerg Med 2022;58:135–40.
38. García-Azorín D, Monje MHG, González-García N, et al. Presence of red flags in patients with cerebral venous sinus thrombosis admitted to the emergency department because of headache. Medicine (Baltimore) 2020;99:e20900.
39. Roberts T, Horner DE, Chu K, et al. Thunderclap headache syndrome presenting to the emergency department: an international multicentre observational cohort study. Emerg Med J 2022;39:803–9.
40. Long D, Koyfman A, Long B. The thunderclap headache: approach and management in the emergency department. J Emerg Med 2019;56:633–41.
41. Roberts T, Horner DE, Chu K, et al. Thunderclap headache syndrome presenting to the emergency department: an international multicentre observational cohort study. Emerg Med J 2022;39:803–9.
42. Starling AJ. Diagnosis and Management of Headache in Older Adults. Mayo Clin Proc 2018;93:252–62.
How to Cite
Subazzoli, D., Mainolfi, F., & Bagattoni, V. (2025). Evaluation of headache by the emergency room nurse. Narrative literature review of the main red-flags and triage models. Scenario® - Il Nursing Nella Sopravvivenza, 42(1). https://doi.org/10.4081/scenario.2025.597
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Aniarti has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.