Background: Acute non-traumatic headache is a common condition in the emergency department (ED), and it is important that these patients are diagnosed appropriately. Failure to recognize the causes of a headache can have serious consequences, including permanent neurologic deficits, loss of vision, and death.

Objective: The present study aims to determine which factors were associated with severe intracranial pathology (SIP) in patients who presented at the ED with acute non-traumatic headache.

Materials and Methods: This was a cross-sectional, analytical study. The population was acute non-traumatic headache patients at the ED of Khon Kaen University’s Srinagarind Hospital from January 1 to December 31, 2018. Data were collected by reviewing hospital information program, medical charts, and PACS. The outcomes were factors associated SIP in acute non-traumatic headache according to multiple logistic
regression analysis and final diagnosis.

Results: The risk factors associated with SIP were Neck stiffness (OR 16.95, p<0.05, 95% CI 2.60, 110.65), fever (OR 5.48, p<0.05, 95% CI 1.42, 21.07), male (OR 5.25, p<0.05, 95% CI 1.70, 16.26), history of hypertension (OR 4.03, p<0.05, 95% CI 1.09, 14.86), and pain score of 7 to 10 (OR 2.36, p<0.05, 95% CI 1.01, 5.51). The most common final diagnoses in SIP and Non-SIP patients were vascular causes and primary headache, respectively.

Conclusion: Neck stiffness was the most important factor associated with severe intracranial pathology. Physicians should extend their information gathering with regard to this factor in order to catch more effectively life-threatening conditions.

Keywords: Acute non-traumatic headache, Severe intracranial pathology, Emergency department