The headache in the Emergency Department

Area of Science:

• Emergency Medicine
• Neurology

Background:

• Headache is a frequent emergency department complaint, accounting for 0.36%-2.5% of visits.
• While rarely indicating high-risk diseases, differentiating serious causes is mandatory.

Purpose of the Study:

• To guide emergency physicians in diagnosing various headache categories.
• To outline diagnostic and therapeutic pathways for emergency department patients presenting with headaches.

Main Methods:

• Careful patient history including pain characteristics, onset, duration, and associated symptoms.
• Thorough neurological examination, fundus oculi inspection, and nuchal rigidity assessment.
• Utilizing laboratory tests (e.g., inflammation index) and imaging (CT scan), with cerebrospinal fluid analysis (rachicentesis) for suspected meningitis or subarachnoid hemorrhage.

Main Results:

• Distinguishing between essential and secondary headaches is key.
• CT scans can exclude organic intracranial causes; rachicentesis is vital for diagnosing meningitis or subarachnoid hemorrhage when CT is negative.
• Specific conditions like subarachnoid hemorrhage, intracranial hypertension, and temporal arteritis require careful differential diagnosis.

Conclusions:

• Emergency physicians must be knowledgeable about diverse headache types for accurate diagnosis.
• A systematic approach combining history, examination, and investigations is essential for managing headache presentations in the emergency department.
• Understanding the differential diagnosis of serious headaches ensures appropriate patient care and consultation.