Background and Objectives: There is scarce data about the epidemiology, clinical features, investigations, diagnosis, treatment, and outcome in patients attending Singapore emergency departments (EDs) with nontraumatic headache. We sought to describe these characteristics of adult patients presenting to the ED with a primary complaint of headache. Materials and Methods: We performed a cross-sectional study on adult patients with nontraumatic headache over 4 consecutive weeks from 18 March 2019 to 14 April 2019 across four EDs in Singapore. Exclusion criteria were history of head trauma within 48 h of presentation, missing records, interhospital transfers, representation with the same headache as a recent previous visit and headache as an associated symptom. Results: During the study period, 579 patients (representing 1.8% of the total ED census) comprising 55.3% males and with a median age of 36 years presented to the four Singapore EDs with a primary complaint of nontraumatic headache. Paracetamol (41.5%), non-steroidal anti-inflammatory drugs (34.4%) and tramadol (31.5%) were the three commonest analgesics used either singly or in combination. Prochlorperazine (22.9%) and metoclopramide (17.4%) were frequent anti-emetic adjuncts. One-third of patients had computed tomography of the brain performed, which found abnormalities among 20.9% of them. ED diagnoses of primary headache conditions were made in 73.6% of patients. Conclusions: Primary headaches constituted most ED headache diagnoses. ED imaging of selected patients yielded a relatively high pick-up rate for significant intracranial abnormalities. Opioid use for symptomatic relief of headaches in the ED was found to be high, underscoring the need for improvement in headache analgesia relief practices in the ED.

Background and Objectives: The increasing prevalence of end-of-life care needs in the emergency department necessitates training for emergency staff in managing terminal symptoms, facilitating serious illness conversations and ensuring goal-concordant interventions. This study aims to evaluate the longitudinal effects of an end-of-life care educational intervention on various emergency professionals. Materials and Methods: An interrupted time series study was conducted among emergency physicians and nurses at three public healthcare institutions over two-and-a-half years. The study had three phases: Phase 1—5 pre-intervention surveys, Phase 2—intervention with an online training course, and Phase 3—5 post-intervention surveys. The impact of the intervention was scored based on staff perceptions of end-of-life care in 3 domains: 1. Knowledge of palliative care (Knowledge), 2. Quality of end-of-life care provided (Care), and 3. Ability to communicate with patients and families (Communication). Results: There were 990 participants with 6450 questionnaires distributed and an 87% response rate of completed questionnaires. Phase 3 had generally higher levels of agreement in all 3 domains compared to Phase 1, with a continued upward trend in Knowledge scores. Upward trends in the Care and Communication domains were less pronounced. Among the 631 (out of 990) participants who completed the training, test scores showed a median improvement of 37.5% (p < 0.001). Conclusions: This study supports the feasibility of online end-of-life care training tailored specifically for emergency professionals, with promising results in the Knowledge, Care, and Communication domains. The findings can help guide the further development of training programs or the adoption of similar interventions for basic palliative care training for emergency physicians and nurses.