Utilizing biomarkers for rapid assessment of headache in the emergency department

Abstract

INTRODUCTION: Headache is a common presenting complaint in emergency departments (EDs), accounting for 2–5% of admissions. Although most headaches are benign, 4–5% are associated with life-threatening secondary pathologies. Accurate and rapid diagnosis is crucial, yet a standardized protocol for imaging and laboratory assessments is lacking. This study evaluates hematologic parameters as diagnostic tools for predicting acute pathologies in patients presenting with headaches. MATERIAL AND METHODS: This retrospective study included 199 headache patients and 191 controls, aged 18 and above, who presented to the Ankara Etlik City Hospital between October 1 and December 15, 2022. Hematologic parameters, including neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were analyzed, and compared with non-contrast brain computed tomography findings in patients with severe headaches. RESULTS: NLR and NPR were significantly elevated in patients with acute pathologies on brain imaging. While platelet levels did not differ, indices like PLR and SII were elevated, indicating their diagnostic potential. Female patients were more prevalent; however, severe headaches and intracranial pathologies were more common in older male patients. CONCLUSIONS: Hematologic parameters such as NLR, NPR, and SII serve as cost-effective, accessible biomarkers for stratifying headache patients in the ED. These markers can guide decisions on further imaging, particularly in high-risk populations. Future multicenter studies should validate these findings and explore their integration into clinical decision-making algorithms.