Cephalalgia
Conditions
Keywords
Cephalalgia, Headache, Migraine, Pain, Global, Treatment, Oxygen, Emergency, Treatment of cephalalgia in emergency department
Brief summary
The purpose of this study is to determine if the use of a therapeutic and global protocol to relieve cephalalgia is helpful in the emergency department of Grenoble University Hospital.
Detailed description
Cephalalgia is a very common symptom that justifies daily appointment in emergency department. Analgesic support, and especially use of oxygen and care of associated symptoms as nausea, photophobia or phonophobia, is very dependent on the physician. The aim of this study is to evaluate the impact of a global analgesic protocol of cephalalgia in emergency department. The investigators included 200 patients aged of 18 up to 55 years old coming in emergency department for headache. Pain (Visual analogic scale), nausea, photo or phonophobia are recorded each 15 minutes by the patient by using a self-assessment questionnaire. The final diagnosis is recorded by the physician in charge of patient, using International Headache Society criteria. First 100 patients(group 1) receive usual care. For the last 100 patients (group 2), physician in charge of patients are incited to use a formal protocol that include: putting the patient in a quiet spot, laying down on a stretcher, providing sound proof helmet and light blocking google, administering oxygen therapy 15 l/min during 15 min, and administering etiological headache adapted medication following learned society guidelines. Comparison of the data of this 2 groups shall help us to see if the investigators actual analgesic support of cephalalgia is efficient, and if it can be improved by this global analgesic protocol.
Interventions
OTHERRecommendation to use global headache treatment protocol
The global treatment protocol is : 1. Put the patient in a quiet spot, ideally an individual room. Avoid waiting in the corridor 2. Lay down the patient on the stretcher. Avoid waiting on a seat or a chair. 3. Provide a sound-proof helmet to the patient. 4. Provide a light-blocking google to the patient. 5. If judged necessary by the physician in charge of the patient, administer oxygen therapy, 15 liter per minute, during 15 minutes. 6. If judged necessary by the physician in charge of the patient, administer analgesic treatment adapted to the etiology of the cephalalgia as described : Migraine : acetylsalicilyc acid + metoclopramide or nonsteroidal anti inflammatory or paracetamol or triptan. Tension headache : nonsteroidal anti inflammatory or paracetamol. Avoid methylmorphine or tramadol if possible. Cluster headache : Intravenous or nasal spray sumatriptan and oxygen therapy. Other etiology : Treatment left at the discretion of the physician in charge of the patient.
Sponsors
University Hospital, Grenoble
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Complain about cephalalgia * Age 28 to 55 years.
Exclusion criteria
* Fever \> 38,0 °C * History of breath disease, long term use of oxygen therapy, chronic obstructive pulmonary disease, dyspnea * History of cranial traumatism, heart attack, cerebrovascular accident \<3 month * Inability to read or understand french. * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical improvement | 1 hour after treatment | Clinical improvement is defined as Reduction of at least 50% of quantified pain 1 hour after treatment Comparison of proportion of clinical improvement between the 2 groups. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain depending on the kind of cephalalgia | 1 hour after treatment | Research of interaction between the occurrence of the clinical improvement and the cephalalgia diagnosis (Migraine, tensive headache, cluster headache, secondary headache...). |
| Impact of different kind of analgesic therapeutic | 1 hour after treatment | Research of interaction between the occurrence of clinical improvement and the use of specific therapeutic strategy ( Restful position, calm environment, wearing opaque glasses, soundproof headset, oxygen therapy, other medication, ...) |
| Pain score on the visual analog scale | 1 hour after treatment | Measure of amount of pain by recording quantified pain evaluation each 15 minutes. Analysis by ANOVA (Analysis of Variance). Comparison between the 2 groups. |
| Time required before medication | Time of administration of first medication, an expected average of 30 minutes | Evaluation of the length of time before first administration of analgesic treatment. Comparison between the 2 groups |
| Hospitalisation requirement | Exit of emergency department, an expected average of 6 hours | Evaluation of hospitalisation requirement at the exit of emergency department. Comparison between the 2 groups |
| Length of the hospitalization in emergency department | Duration of hospitalisation in emergency department stay, an expected average of 6 hours | Evaluation of the length of the hospitalization in emergency department. Comparison between the 2 groups |
Countries
France
Outcome results
None listed