Benjamin W Friedman1, Kayla Babbush2, Eddie Irizarry3, Deborah White3, E John Gallagher3. 1. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA. Electronic address: befriedm@montefiore.org. 2. Medical College, Albert Einstein College of Medicine, Bronx, NY, USA. 3. Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA.
Abstract
BACKGROUND:Headache is a frequent complaint among the 1.4 million patients who present to US emergency departments (ED) annually following trauma to the head. There are no evidence-based treatments of acute post-traumatic headache. METHODS: This was an ED-based, prospective study of intravenous (IV) metoclopramide 20mg+diphenhydramine 25mg for acute post-traumatic headache. Patients who presented to our EDs with a moderate or severe headache meeting international criteria were enrolled and followed by telephone 2 and 7days later. The primary outcome was "sustained headache relief" (headache level less than "moderate" in the ED, no additional headache medication, and no relapse to headache worse than "mild").We also gathered data on associated symptomotology using the validated Post Concussion Symptom Scale (PCSS). RESULTS:21 patients were enrolled. Twelve of 20 (60%) patients with available follow-up data reported sustained headache relief. All but one of the 21 enrolled patients (95%) reported improvement of headache to no worse than mild. Seven of 19 (37%) patients with available data reported moderate or severe headache during the 48h after ED discharge. One week later, 5/19 patients reported experiencing headaches "frequently" or "always". The mean Post Concussion Symptom Score improved from 47.5 (SD 29.4) before treatment to 10.9 (SD 14.8) at the time of ED discharge and 11.4 (SD 21.4) at one week after treatment. CONCLUSION:IV metoclopramide 20mg+diphenhydramine 25mg is an effective and well-tolerated medication regimen for patients presenting to the ED with acute post-traumatic headache, though 1/3 of patients report headache relapse after ED discharge and 1/4 of patients report persistent headaches one week later.
RCT Entities:
BACKGROUND:Headache is a frequent complaint among the 1.4 million patients who present to US emergency departments (ED) annually following trauma to the head. There are no evidence-based treatments of acute post-traumatic headache. METHODS: This was an ED-based, prospective study of intravenous (IV) metoclopramide 20mg+diphenhydramine 25mg for acute post-traumatic headache. Patients who presented to our EDs with a moderate or severe headache meeting international criteria were enrolled and followed by telephone 2 and 7days later. The primary outcome was "sustained headache relief" (headache level less than "moderate" in the ED, no additional headache medication, and no relapse to headache worse than "mild").We also gathered data on associated symptomotology using the validated Post Concussion Symptom Scale (PCSS). RESULTS: 21 patients were enrolled. Twelve of 20 (60%) patients with available follow-up data reported sustained headache relief. All but one of the 21 enrolled patients (95%) reported improvement of headache to no worse than mild. Seven of 19 (37%) patients with available data reported moderate or severe headache during the 48h after ED discharge. One week later, 5/19 patients reported experiencing headaches "frequently" or "always". The mean Post Concussion Symptom Score improved from 47.5 (SD 29.4) before treatment to 10.9 (SD 14.8) at the time of ED discharge and 11.4 (SD 21.4) at one week after treatment. CONCLUSION: IV metoclopramide 20mg+diphenhydramine 25mg is an effective and well-tolerated medication regimen for patients presenting to the ED with acute post-traumatic headache, though 1/3 of patients report headache relapse after ED discharge and 1/4 of patients report persistent headaches one week later.
Authors: Serena L Orr; Benjamin W Friedman; Suzanne Christie; Mia T Minen; Cynthia Bamford; Nancy E Kelley; Deborah Tepper Journal: Headache Date: 2016-06 Impact factor: 5.887
Authors: Benjamin W Friedman; Brooke Bender; Michelle Davitt; Clemencia Solorzano; Joseph Paternoster; David Esses; Polly Bijur; E John Gallagher Journal: Ann Emerg Med Date: 2008-09-23 Impact factor: 5.721
Authors: Benjamin W Friedman; Victoria Adewunmi; Caron Campbell; Clemencia Solorzano; David Esses; Polly E Bijur; E John Gallagher Journal: Ann Emerg Med Date: 2013-04-06 Impact factor: 5.721
Authors: Benjamin W Friedman; Jason West; David R Vinson; Mia T Minen; Andrew Restivo; E John Gallagher Journal: Cephalalgia Date: 2014-06-19 Impact factor: 6.292
Authors: Benjamin W Friedman; Eddie Irizarry; Darnell Cain; Arianna Caradonna; Mia T Minen; Clemencia Solorzano; Eleftheria Zias; David Zybert; Michael McGregor; Polly E Bijur; E John Gallagher Journal: Neurology Date: 2021-03-24 Impact factor: 9.910
Authors: Martina Guglielmetti; Gianluca Serafini; Mario Amore; Paolo Martelletti Journal: Int J Environ Res Public Health Date: 2020-06-05 Impact factor: 3.390