Skip to main content

Advertisement

SpringerLink
Log in

Headache in the emergency room: the role of immigrant background on the frequency of serious causes and diagnostic procedures

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Headache is the most frequent neurological chief complaint in the emergency room (ER). During diagnostic workup, accurate history taking still is the mainstay for identification of patients with a serious underlying disorder. However, in patients with an immigrant background, language problems and cultural influences on pain perception and pain-associated behavior can pose serious challenges for physicians. Here, we have evaluated the epidemiological characteristics of the chief complaint headache in ER patients with a probable immigrant background. We performed a retrospective study on 4,132 consecutive neurological ER patients. Identification of patients with probable immigrant background was done by a name based algorithm. Epidemiological characteristics of ER headache patients with and without probable immigrant background were evaluated. Patients with a probable immigrant background had a higher frequency of headache as chief complaint compared to age- and sex-matched control patients (32 vs. 21%). In addition, headache patients with a probable immigrant background had a lower frequency of serious causes (5.2 vs. 16%). Approximately eight cranial imaging procedures and three lumbar punctures were performed for one serious diagnosis in patients with a probable immigrant background. In control patients, these ratios were three and one, respectively. Taken together, our data suggest that socio-cultural factors such as migrational status significantly affect pain-associated behavior of headache patients as well as the clinical workup in an ER. Culturally competent care may be optimized by interpreters, standardized headache questionnaires and easy access to cranial imaging when a benign etiology cannot be firmly established.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Olazaran J, Navarro E, Galiano M, Vaquero A, Guillem A, Villaverde F, Fernandez Y (2009) Quality of neurological care in the emergency services: a study from the community-hospital. Neurologia 24:249–254

    PubMed  CAS  Google Scholar 

  2. de Falco FA, Sterzi R, Toso V, Consoli D, Guidetti D, Provinciali L, Leone MA, Beghi E (2008) The neurologist in the Emergency Department. An Italian nationwide epidemiological survey. Neurol Sci 29:67–75

    Article  PubMed  Google Scholar 

  3. Royl G, Ploner CJ, Mockel M, Leithner C (2010) Neurological chief complaints in an emergency room. Nervenarzt 81:1226–1230

    Article  PubMed  CAS  Google Scholar 

  4. Sahai-Srivastava S, Desai P, Zheng L (2008) Analysis of headache management in a busy emergency room in the United States. Headache 48:931–938

    Article  PubMed  Google Scholar 

  5. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, Johnston KL, Cipolle RJ, Barber DL (1997) Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol 54:1506–1509

    Article  PubMed  CAS  Google Scholar 

  6. Linn FH, Wijdicks EF, van der GY, Weerdesteyn-van Vliet FA, Bartelds AI, van Gijn J (1994) Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet 344:590–593

  7. Landtblom AM, Fridriksson S, Boivie J, Hillman J, Johansson G, Johansson I (2002) Sudden onset headache: a prospective study of features, incidence and causes. Cephalalgia 22:354–360

    Article  PubMed  Google Scholar 

  8. Schenker MB (2010) A global perspective of migration and occupational health. Am J Ind Med 53:329–337

    Article  PubMed  Google Scholar 

  9. Norredam M, Mygind A, Nielsen AS, Bagger J, Krasnik A (2007) Motivation and relevance of emergency room visits among immigrants and patients of Danish origin. Eur J Public Health 17:497–502

    Article  PubMed  Google Scholar 

  10. Eschbach K, Kuo YF, Goodwin JS (2006) Ascertainment of Hispanic ethnicity on California death certificates: implications for the explanation of the Hispanic mortality advantage. Am J Public Health 96:2209–2215

    Article  PubMed  Google Scholar 

  11. DeFrank JT, Bowling JM, Rimer BK, Gierisch JM, Skinner CS (2007) Triangulating differential nonresponse by race in a telephone survey. Prev Chronic Dis 4:A60

    Article  PubMed  Google Scholar 

  12. Winter H, Cheng KK, Cummins C, Maric R, Silcocks P, Varghese C (1999) Cancer incidence in the south Asian population of England (1990–92). Br J Cancer 79:645–654

    Article  PubMed  CAS  Google Scholar 

  13. Mangtani P, Maringe C, Rachet B, Coleman MP, dos SS I (2010) Cancer mortality in ethnic South Asian migrants in England and Wales (1993–2003): patterns in the overall population and in first and subsequent generations. Br J Cancer 102:1438–1443

    Article  PubMed  CAS  Google Scholar 

  14. dos Santos Silva I, Mangtani P, De Stavola BL, Bell J, Quinn M, Mayer D (2003) Survival from breast cancer among South Asian and non-South Asian women resident in South East England. Br J Cancer 89:508–512

    Article  PubMed  CAS  Google Scholar 

  15. Gupta M, Doobay AV, Singh N, Anand SS, Raja F, Mawji F, Kho J, Karavetian A, Yi Q, Yusuf S (2002) Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. CMAJ 166:717–722

    PubMed  Google Scholar 

  16. Manaseki S, Hawker J, Ali S (2004) Ethnic inequalities in campylobacter infection in Birmingham, UK: descriptive study of notified cases. J Epidemiol Community Health 58:278–279

    Article  PubMed  CAS  Google Scholar 

  17. Vilming B, Nesheim BI (2000) Hyperemesis gravidarum in a contemporary population in Oslo. Acta Obstet Gynecol Scand 79:640–643

    PubMed  CAS  Google Scholar 

  18. Bielefeld K (2009) http://www.beliebte-vornamen.de/. Accessed 1 Aug 2009

  19. Razum O, Zeeb H, Akgun S (2001) How useful is a name-based algorithm in health research among Turkish migrants in Germany? Trop Med Int Health 6:654–661

    Article  PubMed  CAS  Google Scholar 

  20. Sachs L, Hedderich J (2006) Angewandte Statistik. Springer, Berlin, p 270

    Google Scholar 

  21. Julious SA (2004) Using confidence intervals around individual means to assess statistical significance between two means. Pharm Stat 3:217–222

    Article  Google Scholar 

  22. Holm S (1979) A Simple Sequentially Rejective Multiple Test Procedure. Scand J Stat 6:65–70

    Google Scholar 

  23. Bouwhuis CB, Moll HA (2003) Determination of ethnicity in children in The Netherlands: two methods compared. Eur J Epidemiol 18:385–388

    Article  PubMed  Google Scholar 

  24. Gerhards J, Hans S (2009) From Hasan to Herbert: name-giving patterns of immigrant parents between acculturation and ethnic maintenance. AJS 114:1102–1128

    PubMed  Google Scholar 

  25. Bömermann H, Rehkämper K, Rockmann U (2008) Neue Daten zur Bevölkerung mit Migrationshintergrund in Berlin zum Stand 31.12.2007. Zeitschrift für amtliche Statistik Berlin Brandenburg: 20–28

  26. Morgenstern LB, Huber JC, Luna-Gonzales H, Saldin KR, Grotta JC, Shaw SG, Knudson L, Frankowski RF (2001) Headache in the Emergency Department. Headache 41:537–541

    Article  PubMed  CAS  Google Scholar 

  27. Kavuk I, Weimar C, Kim BT, Gueneyli G, Araz M, Klieser E, Limmroth V, Diener HC, Katsarava Z (2006) One-year prevalence and socio-cultural aspects of chronic headache in Turkish immigrants and German natives. Cephalalgia 26:1177–1181

    Article  PubMed  CAS  Google Scholar 

  28. Martinez AM, Tejedor ED (2008) Analysis of neurological assistance demand in immigrant population. Neurologia 23:361–366

    PubMed  Google Scholar 

  29. Buchel F, Frick JR (2005) Immigrants’ economic performance across Europe: does immigration policy matter? Popul Res Policy Rev 24:175–212

    Article  Google Scholar 

  30. Bigal ME, Lipton RB, Winner P, Reed ML, Diamond S, Stewart WF (2007) Migraine in adolescents: association with socioeconomic status and family history. Neurology 69:16–25

    Article  PubMed  CAS  Google Scholar 

  31. Molarius A, Tegelberg A, Ohrvik J (2008) Socio-economic factors, lifestyle, and headache disorders: a population-based study in Sweden. Headache 48:1426–1437

    Article  PubMed  Google Scholar 

  32. Friedman BW, Serrano D, Reed M, Diamond M, Lipton RB (2009) Use of the Emergency Department for severe headache. A population-based study. Headache 49:21–30

    Article  PubMed  Google Scholar 

  33. Shavers VL, Bakos A, Sheppard VB (2010) Race, ethnicity, and pain among the US adult population. J Health Care Poor Underserved 21:177–220

    Article  PubMed  Google Scholar 

  34. Fridriksson S, Hillman J, Landtblom AM, Boive J (2001) Education of referring doctors about sudden onset headache in subarachnoid hemorrhage: a prospective study. Acta Neurol Scand 103:238–242

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Georg Royl, Christoph J. Ploner & Christoph Leithner

Authors
  1. Georg Royl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph J. Ploner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Leithner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georg Royl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Royl, G., Ploner, C.J. & Leithner, C. Headache in the emergency room: the role of immigrant background on the frequency of serious causes and diagnostic procedures. Neurol Sci 33, 793–799 (2012). https://doi.org/10.1007/s10072-011-0830-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-011-0830-y

Keywords

Search

Navigation