Management strategies for acute headache in the emergency department

Approximately 2.1 million patients per year present to United States emergency departments with a primary headache disorder. For emergency clinicians, the responsibility is twofold: First, exclude causes of headaches that pose immediate threats to the life and welfare of patients. Second, provide safe, effective, and rapid treatment of symptoms, while facilitating discharge from the emergency department with appropriate follow-up. While emergency management focuses on identification and treatment of life-threatening causes of headache, such as subarachnoid hemorrhage or bacterial meningitis, there is a tendency to misdiagnose specific primary headache disorders and fail to provide consistent, effective treatments in accordance with published guidelines. These mistakes can be avoided by resisting the temptation to label patients with specific primary headache diagnoses and by adopting a consistent, reproducible strategy for treatment of primary headache disorders in the emergency department that is evidence-based and effective.