Protocol to Ease Acute Cephalalgia in Emergency-department
Condition: Cephalalgia
MeSH terms: Emergencies; Headache
Study type: Interventional

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.
    

Intervention name(s): Recommendation to use global headache treatment protocol
Intervention type(s): Other
Intervention description(s): The global treatment protocol is :
Put the patient in a quiet spot, ideally an individual room. Avoid waiting in the corridor
Lay down the patient on the stretcher. Avoid waiting on a seat or a chair.
Provide a sound-proof helmet to the patient.
Provide a light-blocking google to the patient.
If judged necessary by the physician in charge of the patient, administer oxygen therapy, 15 liter per minute, during 15 minutes.
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.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cephalalgia; Headache; Migraine; Pain; Global; Treatment; Oxygen; Emergency; Treatment of cephalalgia in emergency department