Optic nerve sheath diameter measurement in patients with headache in the emergency department

The purpose of headache management in emergency department (ED) is to discriminate the causes of life-threatening headache. Purpose of this study is to investigate the effectiveness of sonographic optic nerve sheath diameter (ONSD) measurements in predicting secondary headache that causes increased ICP and to evaluate its usability in the management of secondary headaches. The study included 106 patients over 18-year-old who admitted to Hacettepe University Emergency Department with headache. Brain CT was performed in all patients with a preliminary diagnosis of secondary headache. Sonographic ONSD measurement was performed in all patients. The data were used to predict the presence of pathological findings in CT, to predict secondary headache and to show the requirement of hospitalization. Of the 106 patients, 47 were male and 59 were female, and the mean age was 48.95. The most common secondary headache causes were hypertensive headache (n:15), intracranial mass (n:10), subarachnoid hemorrhage (n:8). Secondary headache diagnosis was corrected with CT. ONSD value (0.51±0.05) of patients with secondary headache was higher than in patients with primary headache (0.41±0.04) (p: 0.01). The diagnostic value of ONSD measurements in predicting pathology in CT was evaluated through ROC analysis. The cut-off value of ONSD was found to be 0.51 (sensitivity: 93.55% specificity: 65.33%). The ROC curve analysis was performed to investigate the cut-off value of the ONSD in predicting secondary headache. The highest sensitivity and specificity were found to be 0.51 (sensitivity: 88.46% specificity: 90.74%). The ROC curve analysis was performed to investigate the cut-off value of ONSD for the requirement of hospitalization in study group. The cut-off value of ONSD was found to be 0.53 (sensitivity: 93.10%, specificity: 64.47%). It is known that one of the earliest signs of increased intracranial pressure is enlargement of the optic nerve. In patients admitting to the ED with complaints of headache, sonographic ONSD measurement predicts secondary headaches that cause increased intracranial pressure and is helpful in directing patients to neuroimaging.