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Benign Headache Management in the Emergency Department
1Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas.
The Journal of Emergency Medicine
|February 4, 2018
Summary
Emergency departments effectively treat primary headaches using antidopaminergic agents combined with NSAIDs or acetaminophen. Dexamethasone can prevent recurrence, while other options like ketamine and nerve blocks show promise for headache management.
Area of Science:
- Emergency Medicine
- Neurology
Background:
- Headache is a frequent emergency department (ED) complaint.
- ED physicians prioritize ruling out life-threatening causes of headache.
- Primary headaches are a significant cause of disability.
Purpose of the Study:
- To review and recommend treatments for benign, primary headaches in the ED.
- To synthesize current literature on headache management strategies.
Main Methods:
- Literature review of medication efficacy for primary headache treatment.
- Evaluation of diagnostic criteria and red flags for secondary headaches.
- Analysis of treatment outcomes for various pharmacologic and procedural interventions.
Main Results:
- Antidopaminergic medications combined with NSAIDs or acetaminophen show high efficacy.
- Dexamethasone can decrease headache recurrence.
- Intravenous fluids are indicated for dehydration; diphenhydramine is not for pain relief.
- Ketamine, propofol, and nerve blocks show potential therapeutic benefits.
Conclusions:
- Antidopaminergic agents with NSAIDs/acetaminophen are highly effective for primary headaches in the ED.
- Dexamethasone may reduce headache recurrence.
- Emerging treatments include ketamine, propofol, and nerve blocks.
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