Headache Medicine 2021, 12(4):343-345 p-ISSN 2178-7468, e-ISSN 2763-6178
343
ASAA
DOI: 10.48208/HeadacheMed.2021.58
Headache Medicine
© Copyright 2021
Short Communication
Mnemonic method in Portuguese for headaches in emergency room
Hilton Mariano da Silva Júnior , Larissa Volpini Cardoso
Pontificial Catholic University of Campinas, Faculty of Medicine, Department of Semiology, Campinas, Sao Paulo, Brazil
Larissa Volpini Cardoso
email: volpinilc@gmail.com
telephone: +55 (19) 99378-9881
Received: January 19, 2022
Accepted: January 24,2022
Keywords:
Headache
Emergencies
Method
Abstract
Background
It is of crucial importance to quickly stratify the risk of patients with headaches in the emer-
gency setting, and mnemonics can be used to remember the alarm criteria in those cases.
Such mnemonics were written in English and Spanish, but none in Portuguese.
Objective
To present the rst mnemonic method in Portuguese for alarm criteria in emergency headaches
in order to facilitate their identication and diagnosis.
Methods
A search was made through different databases for a mnemonic method regarding alarm
criteria in emergency headaches that was written in Portuguese. None were found. Thus,
the emergency criteria were gathered and turned into a mnemonic in Portuguese.
Results
We present the mnemonic method “RISADA PEGA”.
Conclusion
We believe this tool can be very useful in teaching and clinical settings.
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Silva Júnior HM, Cardoso LV
Mnemonic method in portuguese for headaches in emergency room
Introduction
T
he assistance provided at the Emergency Department is
underlined by unplanned attendance that poses challeng-
es to health professionals. The access to patients’ medical
history, the wide spectrum of diagnosis and the numerous
patients who require immediate attention are issues physi-
cians face in this scenario. In this fast-paced environment,
having a strong memory is valuable, since decisions are to
be taken fast and precisely. Mnemonics assist the brain to
store information safely. They were used by Greek students
to recall information and may prove to be useful in the hectic
emergency rooms.
In clinical practice its use is widely disseminated, as it
improves retention of clinical concepts and enriches the
generation of differential diagnoses. In the neurology
specialty, mnemonics have assisted in the recognition of
alarm criteria for headaches in the emergency setting.
Neurological emergencies are characterized by a
sudden onset, poor prognosis, and possible need for
immediate resuscitation.
1
In the emergency department,
acute headaches are presented by 2%-4% of admitted
patients
2-4
, and secondary headaches are associated with
high morbidity and mortality.
5,6
In this context, mnemonics were created for alarm
criteria in emergency headaches: in English there is the
“SNOOP4”
7
, and in Spanish there are the “NI ESPPERE”
and “PPIENSENLo”.
After searching different databases, we were not able to
nd a mnemonic method for these criteria that was written
in Portuguese.
The Mnemonic Method
With that in mind, the method “RISADA PEGA” (“laughter
spreads”, in English) was created. It stands for:
R - Repentina / (Sudden onset)
I - Início depois dos 50 anos / (onset in a patient older
than 50)
S - Sinais e/ou sintomas de doenças sistêmicas ou
neurológicas / (Signs and/or symptoms of systemic or
neurologic diseases)
A - Anormalidades no exame neurológico / (abnormalities
upon neurologic examination)
D - Depressão da imunidade (AIDS, Câncer) / Depressed
immunity (HIV or cancer)
A - Antecedentes: doenças que podem acometer o SNC;
número de vindas ao PS, história familiar de cefaleia) /
(prior conditions: diseases affecting the central nervous
system; number of visits to the health center, history of
headache in the family)
P - Padrão alterado (mudança no padrão anterior da
cefaleia) / (change in headache pattern)
E - Esforço / (exertion; effort, headaches with Valsalva's
maneuver or headache associated with sexual activity)
G - Gravidez / (pregnancy)
A - Autonomia (sinais autonômicos) / (autonomic signs)
Conclusion
Secondary headaches are challenging complaints in
the emergency setting, and they require a meticulous
investigation of the patient’s history and physical
examination so that the patient’s risk is properly
evaluated.
1,5
Time is an important factor, since there
are time constraints for diagnosis and initial treatment
in the emergency department.
1
This shows the usefulness
of a method to quickly identify the alarm criteria and,
through that, correctly stratify the patient's risk and initiate
treatment.
As far as we know, this is the rst mnemonics in Portuguese
for the alarm criteria in emergency headaches. We
believe this is a useful tool for Portuguese speaking
medical students and clinical practitioners. Furthermore,
it may be a way to educate patients and their families.
Conflicts of interest: There is no conict of interest.
Authors' contribution: the authors also contributed
Financing: no nancing
Larissa Volpini Cardoso
https://orcid.org/0000-0002-4226-9708
Hilton Mariano da Silva Júnior
https://orcid.org/0000-0002-9778-9946
References
1. Speciali JG. KF, Jurno ME., et. al. Protocolo Nacional
para diagnóstico e manejo das cefaleias nas unidades
de urgência do Brasil. Academia Brasileira de
Neurologia – Departamento Cientíco de Cefaleia:
Sociedade Brasileira de Cefaleia; 2018 Available from:
https://neurologiahu.paginas.ufsc.br/les/2012/08/
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Silva Júnior HM, Cardoso LV
Mnemonic method in portuguese for headaches in emergency room
Protocolo-nacional-para-diagnóstico-e-manejo-das-
cefaleias-nas-unidades-de-urgência-do-Brasil_2018.pdf
2. Marl A, DeLaGarza-Pineda O and Barrera-Barrera
SA. PPIENSENLo: A Novel Mnemonics in Spanish for
Alarm Criteria in Secondary Headaches in Children.
Headache
2018;58(10):1682-1684 Doi:10.1111/
head.13384
3. Guryildirim M, Kontzialis M, Ozen M and
Kocak M. Acute Headache in the Emergency
Setting.
Radiographics
2019;39(6):1739-1759
Doi:10.1148/rg.2019190017
4. Nye BL and Ward TN. Clinic and Emergency Room
Evaluation and Testing of Headache.
Headache
2015;55(9):1301-1308 Doi:10.1111/head.12648
5. Longoni M and Agostoni EC. Headache in neurological
emergency.
Neurol Sci
2020;41(Suppl 2):409-416
Doi:10.1007/s10072-020-04761-3
6. Goldstein JN, Camargo CA, Jr., Pelletier AJ and Edlow
JA. Headache in United States emergency departments:
demographics, work-up and frequency of pathological
diagnoses.
Cephalalgia
2006;26(6):684-690
Doi:10.1111/j.1468-2982.2006.01093.x
7. Filler L, Akhter M and Nimlos P. Evaluation and
Management of the Emergency Department
Headache.
Semin Neurol
2019;39(1):20-26
Doi:10.1055/s-0038-1677023