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Evaluating and managing severe headache in the emergency department
Michelangelo Luciani1, Andrea Negro1,2, Valerio Spuntarelli1
1Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
Expert Review of Neurotherapeutics
|December 10, 2020
Summary
Headache management in emergency departments (ED) often involves misdiagnosis and inadequate treatment for primary headaches. Improving primary care and ED protocols can reduce inappropriate ED use and enhance patient care.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Headache is a frequent reason for emergency department (ED) visits, often benign and primary, like migraine.
- Inappropriate ED use for non-emergency headaches leads to overcrowding, excessive testing, and increased healthcare costs.
Purpose of the Study:
- To review headache management in the ED, including diagnosis, investigation, treatment, and follow-up.
- To identify gaps in primary headache care within emergency settings.
Main Methods:
- Comprehensive review of headache management stages in the ED.
- Evaluation of diagnostic accuracy, therapeutic interventions, and discharge planning.
- Analysis of follow-up recommendations and headache recurrence.
Main Results:
- Primary headaches are frequently underdiagnosed or misdiagnosed in EDs.
- Most patients with primary headaches do not receive adequate or specific drug therapy.
- Headache often persists at discharge or recurs within 24 hours.
Conclusions:
- Enhanced primary care services and "headache culture" education for healthcare professionals are crucial.
- Adopting standardized diagnostic protocols (e.g., ICHD) and facilitating rapid referrals to headache centers can improve ED efficiency and headache patient outcomes.
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