Abstract
Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.1 While the overwhelming majority of patients present with a primary headache disorder, particularly migraine, the emergency physician’s role calls for the simultaneous exclusion of severe or life-threatening pathology while providing judicious and effective symptom relief.2 Notably, recent investigations suggest that this dual mandate performs well, excluding more than 99% of conditions resulting in serious adverse neurologic sequelae, though at the cost of high-frequency and low-yield advanced imaging utilization.3, 4 While a comprehensive understanding of the diagnostic process and underlying pathophysiology associated with headache disorders is critical for the emergency clinician, this review is meant to chiefly describe the treatment of primary headache and the variety, efficacy, and indications of those interventions. While individual headache type classification can be helpful in targeting approach or therapy, diagnosis can be difficult in the emergency setting, and primary headaches of most types are often approached similarly in the ED. Interestingly, the overwhelming majority of patients who present to an emergency department with acute primary headache have migraine, but the majority of patients receive a less specific diagnosis and a treatment that is correspondingly nonspecific.5 Importantly, however, the dynamic, diverse, and unique nature of different headache presentations to the ED make an algorithmic or step-wise approach to headache management ill-advised. The emergency practitioner must have a working knowledge of the array of treatment options available and apply therapies in a considered and informed manner. Following effective analgesia, however, the most important intervention emergency physicians can deliver for their headache patients is to connect them with outpatient physicians savvy about headache management, who will then provide these headache patients with appropriate acute therapeutics, initiate preventive therapy and provide anticipatory guidance about their disease process.6
Highlights
Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.[1]
While a comprehensive understanding of the diagnostic process and underlying pathophysiology associated with headache disorders is critical for the emergency clinician, this review is meant to describe the treatment of primary headache and the variety, efficacy, and indications of those interventions
While individual headache type classification can be helpful in targeting approach or therapy, diagnosis can be difficult in the emergency setting, and primary headaches of most types are often approached in the ED
Summary
Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.[1]. When infusion is slowed or adjunctive medications are given to mitigate the akisthetic side effects of antidopaminergic agents (as in the case of prochlorperazine), most patients have superior outcomes when compared to sumatriptan administration.[41] for patients in whom neuroleptic therapy is not available or not appropriate, triptans remain a reasonable first-line option for emergency management of primary headache.[42] The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies suggests that subcutaneous sumatriptan should be offered to adults who present to an ED with acute migraine.[43] Common dosing of triptans is listed in (Table 3). Considering the low side effect profile of these modalities, it is likely in the future that they will become more popular in the emergency treatment of headache disorders
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
