Headache and emergency medicine: sharing a language for a common project

Abstract

Headache ranks as fifth among the most common medical complaints leading to emergency departments (EDs) [1]. Every day, emergency rooms (ERs) admit about 2–3% of patients requiring medical assistance for a diagnosis of headache. Woldwide, a ‘‘nation’’ of millions people demands to ER physicians specific expertise on headache. Such physicians are mostly specialists in internal and emergency medicine with general competences of headache management, which often produces targeted neurological or highly specialised consultations. Secondary headaches account for 4–14% of all acute headache referred to EDs [2, 3]. A CT is performed to exclude secondary causes for headache, and if this is the case, intramuscular anti-inflammatory drugs are often used for acute migraines refractory to self-administered therapy, medication overuse headache and cluster headache attacks, but sometimes, although rarely, they cannot face satisfactorily the diagnostic challenge concerning the benign aetiology of referred headache [4]. These remarks led to a meeting between the two European Federations, which share this topic. In Rome, on 7 May 2008, the European Federation of Internal Medicine (EFIM) hosted the European Headache Federation (EHF) in a Joint Section on ‘‘Emergency Headache’’ during the opening of the 7th EFIM Congress. The major critical issues in EDs requiring greater attention for what concerns the distinction of acute headaches due to secondary causes can be subarachnoid haemorrhage, sentinel haemorrhage from a leaking cerebral aneurysm, intracerebral haemorrhage, subdural haematoma, hypertensive encephalopathy, spontaneous intracranial hypertension, obstructive hydrocephalus, brain tumour, reversible cerebral vasoconstriction syndrome, artery dissection, cerebral venous thrombosis, pituitary apoplexy, temporal arteritis, cardiac cephalgia, cerebral abscess, etc. [5–8]. All these situations demand both a careful anamnestic evaluation and a correct diagnostic algorithm and can be grouped in subtypes such as severe-onset secondary thunderclap headache, transient neurological deficits, neurological deteriorations, headache associated with infections, etc. [6]. Different data come from the few EDs dedicated to headache (HED), which are both general and paediatric, and report a percentage diagnosis of ‘‘primary headache disorders’’ ranging around 67% for the general HEDs [9] and 57% for paediatric HEDs [10]. Evident selection bias to access does not allow comparison and superimposition of data detectable in general EDs and HEDs. Certainly, the crucial passages of this clinical synergy towards a careful research of efficacy outcomes in ERs headache management is based on shared classification guidelines and common therapeutic protocols. For clinical practice in ERs, today, we dispose the International classification of headache disorders: 2nd edition (ICHD-II) of G. Licata Department of Internal Medicine, University of Palermo, Palermo, Italy