Emergency treatment of headache

The first approach in the emergency treatment of headache is the use of abortive measures in an attempt to forestall progression of early signs and symptoms. Abortive measures include analgesics, antiemetics, and anxiolytics; nonsteroidal anti-inflammatory drugs; ergots, generally preceded by administration of an antiemetic; conservative use of corticosteroids; major tranquilizers; and even narcotics (in certain extreme and selective situations). If abortive measures fail, IM or IV administration of dihydroergotamine mesylate, preceded by promethazine (IM) or metoclopramide (IM or IV) and followed by dexamethasone (IM or IV), is an effective emergency procedure. Every patient seeking care for headache from an emergency department should be instructed on how and where to obtain definitive follow-up and long-term treatment.