Vinson D. Treatment patterns of isolated benign headache in U.S. emergency departments.
Bibliographic record
Abstract
Vinson D. Treatment patterns of isolated benign headache in U.S. emergency departments. Ann Emerg Med 2002;39:215–36. The author analyzed the treatment of adult patients with isolated headache who sought treatment at United States emergency departments in light of practice guidelines in the United States and Canada. Data were extracted from the 1998 National Hospital Ambulatory Medical Care Survey, which sampled all visits from 398 emergency departments in the United States over a 4-week period. The migraine headache and unspecified headache cohorts included 811,419 and 604,977 patients respectively. On average, patients received 1.8 medications from a pharmacopeia of 36 drugs. The most common drugs used for the migraine cohort were meperidine (35.7%), promethazine (29.4%), IV ketorolac (16.6%), and prochlorperazine (15.6%). Parental medications were given to 85% of migraine patients. These facts need to be interpreted in light of the fact that 35% of the migraine patients reported moderate headache and only 20% reported severe headache. The American Academy of Neurology recommends an antiemetic (particularly prochlorperazine) plus dihydroergotamine as the therapy of choice for aborting an acute migraine episode. The Canadian Headache Society's algorithm for the treatment of severe migraine headache states that the agent of choice is a dopamine-antagonist antiemetic followed by dihydroergotamine or sumatriptan. The treatment of patients in this study diverged from these recommendations in two ways. First, only one fourth of patients with migraine received a non-opioid agent as part of their drug regimen. Second, opioids were more commonly used as first-line drugs than as second-line drugs reserved for patients who do not respond to non-opioid treatment. The author questioned the heavy reliance on meperidine, because its shorter half-life and potential for dependency make the drug “suboptimal” and a “last resort” choice for therapy, according to the Canadian Headache Society. The study is limited by the absence of data detailing prior medications tried by these patients, as well as the efficacy and tolerance of the medications. There are likely to be patient and physician factors that explain why current practice in emergency rooms differs from the recommended therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".