Acute Primary Headache Research Articles

International standard of Traditional Chinese Medicine Techniques: Traditional Chinese Medicine guidelines for acute primary headache (2022).

To summarize the evidence from Traditional Chinese Medicine (TCM) practice in the treatment of acute primary headache and provide clinical practice guidance. The guidelines were developed in accordance with the World Health Organization guideline development manual. After the establishment of steering committee, panel and the registration and protocol formulation, the evidence on TCM for acute primary headache from published guidelines, clinical evidence, and expert experience and consensus were collected. The grading of recommendations assessment, development and evaluation method was used to grade the evidence and make the recommendations. Based on the available evidence, the guidelines recommended three TCM herbal decoctions, six Chinese patent medicines, and two kinds of external application of Chinese herbal medicines. Diagnostic recommendations based on the expert experience and consensus were also included in the guidelines. TCM diagnosis and treatment of decoction, Chinese patent medicine and external application for treating acute primary headache were recommended. We hope these guidelines will be helpful in standardize the TCM acute treatment of primary headache.

The Effect of Butyrophenones for the Management of Primary Headache in the Emergency Department: A Systematic Review and Meta-Analysis

BACKGROUND: The use of butyrophenones for headaches became plausible when the association was established between dopamine and headache. However, despite their positive effect on acute headaches, their use remains controversial. AIM: The goal of this study is to ascertain whether the addition of haloperidol or droperidol to the treatment regimen for acute primary headache lowers the pain score of adult patients in the emergency department. METHODS: A systematic review and meta-analysis was conducted. We searched the following databases for randomised controlled trials (RCTs): PubMed, Cochrane databases, and grey literature, from 1963 to October 2022. Included were RCTs conducted on the use of butyrophenones (IV haloperidol or IV/IM droperidol) in the acute management of primary headaches (diagnosed or undiagnosed), designated prospective, double-blind or open, using only the Visual Analogue Scale (VAS) with a specific measurement time. We excluded non-English studies that lacked translation, studies conducted on paediatric age groups, and studies conducted on animals. RESULTS: Out of 49 articles we included seven, three of which investigated haloperidol. The mean difference in VAS score favoured haloperidol; -2.46 (95% CI: [-4.11 to -0.81]), indicating a drop in VAS score of 2.5/10 units. The mean difference in VAS score for the use of droperidol was -0.35 (95% CI: [-1.24 to 0.54]). CONCLUSION: Haloperidol can induce an acute 25% reduction in VAS score when added to the regimen for acute headache management. It also reduces the need for rescue medications and improves patient satisfaction. Nonetheless, considerable side effects cannot be overlooked.

Protocols for Traditional Chinese Medicine guidelines for acute primary headache.

To further improve clinical workers' Traditional Chinese Medicine (TCM) treatment level for headache attack, the TCM Guidelines for Acute Primary Headache has been developed based on the development methodology of the World Health Organization Standard Version guide. The grading of recommendations assessment, development and evaluation (GRADE) method was adopted for the development of evidence, evidence classification, and recommendations that can be systematically evaluated. For evidence lacking clinical research support, the quality of evidence was evaluated and recommended based on the evidence level standard of ancient books of traditional Chinese medicine, and The Appraisal of Guidelines for Research and Evaluation II (AGREE II) and The Reporting Items for Practice Guidelines in Healthcare (RIGHT) were referred to. This guideline plan mainly introduces the guideline formulation process of constructing clinical questions and selecting outcome indicators, evidence retrieval, generation of recommendations, etc.

Sodium Metamizole: Regulatory Status around the World, Safety Problems and Medication Errors

Sodium metamizole (SM), analgin, was recalled from the pharmaceutical market by the regulatory authorities of some countries in the mid-60s because of side effects (agranulocytosis). However, there has been a trend towards a steady increase in its prescription rates in the recent decades. The aim of the study was to characterise the regulatory status of SM in different countries of the world, to assess the effectiveness and safety, and to analyse available data on medication errors in real clinical practice. According to the reviewed publications, SM is the most frequently used analgesic in surgical practice in German-speaking countries, the third most frequently prescribed analgesic in Switzerland, and a widely used one even in the countries where it has previously been recalled, such as the USA. The increase in the use of SM, according to experts, is due to the opioid crisis and the high risk of cardiotoxicity of non-steroidal anti-inflammatory drugs (NSAIDs). In chronic pain, the efficacy of SM is superior to that not only of paracetamol, but also of NSAIDs; in postoperative pain and acute primary headache, it is not lower than that of other commonly used analgesics. SM has a pronounced analgesic effect in cancer patients; high doses are comparable to narcotic analgesics in effectiveness but have a significantly more favourable safety profile. Randomised and observational studies confirm that the short-term use of SM is quite safe, including in terms of the risk of developing myelosuppressive side effects. When administered as a course of less than 2 weeks, SM is characterised by a lower frequency of adverse events compared to opioids and an approximately equal one compared to placebo and paracetamol, while longer courses are associated with an increased risk of agranulocytosis. Adverse drug reactions may result from medication errors. The risk of lethal outcome associated with agranulocytosis increases when SM is co-administered with methotrexate or used in elderly patients. In the Russian Federation, SM is an over-the-counter medicinal product approved for a wide range of pain types; it can be used as a highly effective analgesic provided that the dose, route, and frequency of administration are appropriate, the baseline characteristics of patients are taken into account, and unreasonably long courses (more than 2 weeks) are avoided.

Randomised trial of IV metoclopramide vs IV ketorolac in treatment of acute primary headaches.

Headache is one of the most common neurological conditions among emergency department visits (ED), although the best therapy has not been identified yet. Therefore, in the current study, we aimed to compare the pain-relieving effect of metoclopramide and ketorolac in acute primary headaches patients. This double-blind, randomised clinical trial was conducted at Golestan Hospital, Ahvaz, Iran. This research involved all adult patients with acute primary (migraine or tension-type) headaches presented to the ED. Pain intensity was assessed with 0 to 10 verbal Numeric Rating Scales (NRS). The subjects were randomised into 10mg intravenous (IV) metoclopramide or 30mg IV ketorolac groups. Pain score and drug adverse reactions were compared between the two groups at baseline, 15, 30, and 60min after baseline. 108 patients completed this trial and were equally divided into two groups (mean age of 34±8.54years; 57.4% female). Before treatment, the mean pain score was 6.9 and 6.8 in metoclopramide and ketorolac groups, respectively (p>0.05). Metoclopramide failed to provide more improvement in pain score at 30min (p=0.55) and 60min (p=0.15) from baseline. There were no serious adverse events in this study. Only five patients required rescue medication which four of them were in ketorolac group. We were unable to reject the null hypothesis that there would be no difference in pain outcomes between metoclopramide and ketorolac.

Management of Primary Headache in the Emergency Department

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

Management of Primary Headache in the Emergency Department

Headache is a common presentation to emergency departments (EDs), comprising nearly 4% of all ED admissions.‎ 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.‎ 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.‎ 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.‎ 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.‎

Current Approach to Undifferentiated Headache Management in the Emergency Department.

To discuss pharmacological interventions in the emergency department (ED) setting for the management of acute primary headache. Acute headache treatment in the ED has seen an expansion in terms of possible pharmacological interventions in recent years. After a thorough evaluation ruling out dangerous causes of headache, providers should take the patient's history, comorbidities, and prior therapy into consideration. Antidopaminergics have an established role in the management of acute, severe, headache with manageable side-effect profiles. However, recent studies suggest anesthetic and anti-epileptic drugs may play roles in headache treatment in the ED. Current literature also suggest steroids as a promising tool for emergency department clinicians combating the readmission of patients with recurrent headaches. Emergency medicine providers must be cognizant of these traditional and emerging therapies in order to optimize the care of headache patients.

Dipyrone for acute primary headaches

UMMARY Introduction: Headaches commonly affect working-age people. Dipyrone is largely used in many countries. Objectives: To determine effectiveness/safety of dipyrone for adults with acute primary headaches. Method: Double blind randomized controlled trials systematic review. Dichotomous data were expressed as relative risks and risk differences, and continuous data as weighted mean differences. If possible, numbers-needed-to-treat were calculated. Results: Four studies were included (636 subjects). Meta-analysis was possible for one outcome, favouring dipyrone. Regarding episodic tension-type headache and migraine, individual studies data showed dipyrone statistically significant beneficial effect. No severe adverse events were reported. There was no statistically significant difference between dipyrone and placebo regarding mild to moderate adverse events. Conclusion: Dipyrone is effective in migraine and episodic tension-type headache. Conclusions about its safety and agranulocytosis can not be drawn probably due to the relatively small sample. If the results of a recent study, which is related to the incidence of agranulocytosis in Latin America, do not clarify the question, data from observational studies on dipyrone side effects should be searched to determine its safety

Intranasal Lidocaine for Acute Management of Primary Headaches: A Systematic Review.

Intranasal lidocaine has been studied and recommended as an alternative in the management of acute headache. The objective of this systematic review was to evaluate the efficacy and safety of intranasal lidocaine in the acute management of primary headaches. The MEDLINE (1946 to May 2018), EMBASE (1974 to May 2018), Cochrane Central Register of Controlled Trials (2008 to May 2018), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to May 2018), and ClincialTrials.gov online databases were searched. Studies conducted in patients with acute primary headache were included if lidocaine was compared with placebo or alternative treatments, lidocaine dosing was specified, and patients' pain before and after treatment were clearly reported. Six studies met the inclusion criteria. Intranasal lidocaine demonstrated potential benefit over placebo in acute pain reduction and need for rescue medication only in the four studies deemed to be of poor quality, not in the two fair-quality studies. No study reported benefit in preventing headache recurrence or repeat visits to the emergency department. Lidocaine was associated with significantly higher rates of adverse events compared with placebo and may result in lower rates of patient satisfaction. There is insufficient evidence to support the use of intranasal lidocaine in acute management of primary headaches. Further research is warranted to better elucidate whether intranasal lidocaine has a role in the management of specific primary headache subtypes and whether there is an optimal regimen.

The Use, Safety, and Efficacy of Olanzapine in a Level I Pediatric Trauma Center Emergency Department Over a 10-Year Period.

Olanzapine is a second-generation antipsychotic increasingly used in emergency medicine for many indications. Literature on its use in children is sparse. Our objectives were to describe the use, safety, and efficacy of olanzapine in pediatric emergency patients. A structured chart review was performed of patients 18 years old or younger receiving olanzapine from 2007 to 2016 in the emergency department of a pediatric level I trauma center. A total of 285 children received olanzapine. Mean age was 16.4 years (range, 9-18 years); 121 were male (42.8%). Primary indications for olanzapine included agitation (n = 166, 58.3%), headache (n = 58, 20.4%), nausea/vomiting/abdominal pain (n = 37, 12.5%), unspecified pain (n = 20, 7%), and other (n = 4, 1.4%). Route of olanzapine administration was intramuscular (n = 160, 56%; median dose, 10 mg; range, 2.5-20), intravenous (n = 101, 36%; median dose, 5 mg; range, 1.25-5), and oral (n = 24, 8%; median dose, 10 mg; range, 5-10). For agitated patients, 28 (17%) received another sedative within 1 hour. For headache patients, 5 (8.6%) received another analgesic. For gastrointestinal complaints, 5 patients (13.5%) received another analgesic/antiemetic. Adverse respiratory events were hypoxia (pulse oximetry reading, in percentage, <92%; n = 7, 2.4%), supplemental oxygen placement (n = 9, 3.2%), and intubation (n = 2, 0.7%). No patient died or had a dysrhythmia. One patient experienced dystonia. Olanzapine seems safe when used for a variety of conditions in pediatric emergency patients. It may be effective for acute agitation, primary headache, and gastrointestinal complaints.

Comparison of Intravenous Metoclopramide and Acetaminophen in Primary Headaches: a Randomized Controlled Trial.

Headache is the most common neurologic symptom among referees to the emergency department (ED), while the best treatment has not yet been found. Therefore, in the present study pain relief effects of metoclopramide and acetaminophen were compared in patients suffered acute primary headache. This study was a double-blind randomized clinical trial performed in Imam Khomeini Hospital, Urmia, Iran, through July to October 2014. All adult patients, with acute primary (migraine, tension type and cluster) headache referred to the ED were included in this study. Pain severity was measured with 10 centimeters numeric rating scales. The patients were randomized into two groups of intravenous (IV) metoclopramide (10 milligrams) and acetaminophen (1 gram). Pain score, success rate, and drug complications were compared between the 2 groups at 0, 15, 30, 60, and 120 minutes after injection. 100 patients were equally categorized into two groups (mean age of 32 ± 13.2 years; 51.2% male). Initial pain score in metoclopramide and acetaminophen groups were 9.1 and 9.4, respectively (p = 0.46). IV metoclopramide did not have any analgesic effect at 15 minutes, but had good effect at 30 minutes. While, the analgesic effect of acetaminophen initiated after 15 minutes. After 2 hours, both drugs had good therapeutic effect on primary headaches (p < 0.001). The present study demonstrated that efficacy of metoclopramide for pain relief in primary headaches is lower than acetaminophen. In this regard, success rate of acetaminophen was 42.0% versus 0% for metoclopramide within 15 minutes. The efficacy of acetaminophen continued until 60 minutes.

Contribution of verbal suggestion to the therapeutic efficacy of an analgesic agent for acute primary headache.

The therapeutic response of a patient cannot purely be explained by the method of therapy or the efficacy of a drug. Clinician-patient interaction, psychosocial factors, patients' expectations, hopes, beliefs and fears are all related to the healing outcome. Malleability and suggestibility are also important in the placebo or nocebo effect. The purpose of this study was to evaluate whether adding brief verbal suggestions for pain relief could change the magnitude of an analgesic's efficacy. This prospective study was performed in the emergency department of a university hospital. Patients who were ordered analgesia with diclofenac sodium for primary headache were divided into three groups. All groups were informed that they would be administered a pain killer by intramuscular injection. The second and third groups were given positive and reduced treatment expectations about the therapeutic efficacy, respectively. Patients were asked to rate their pain on a VAS at 0 and 45 minutes and if they needed any additional analgesic 45 minutes after the injection. A total of 153 patients were included in the study. The paired univariate analyses showed significant differences for all groups between 0- and 45-minute VAS scores. However, there was no difference between the three groups according to the differences in VAS scores between 45 and 0 minutes and according to the administration of an additional drug. Simple verbal suggestions did not alter the efficacy of an analgesic agent for headache in an emergency setting. The contributions of suggestibility, desire and expectation in acute primary headache patients should be further investigated.

WITHDRAWN: Dipyrone for acute primary headaches.

The original authors of this review are unable to update it. The Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS) is seeking new authors to update and split the review into two separate reviews on migraine and tension‐type headache. If you are interested, please contact the Managing Editor of PaPaS (contact details provided under 'Contact Person'). At July 2014, this review has been withdrawn. This review is out of date although it is correct as of the date of publication. The latest version is available in the ‘Other versions’ tab on The Cochrane Library, and may still be useful to readers.

Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial

IntroductionThis study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting.Methods and...

The efficacy and safety of topiramate for prophylaxis of migraine in children.

Migraine is the most common acute intermittent primary headache in children and prophylactic therapy is indicated in children with frequent or disabling headaches. The purpose of this study was to evaluate the efficacy and safety of topiramate (TPM) for migraine prophylaxis in children. In a quasi-experimental study, monthly frequency, severity and duration of headache, migraine disability, and side-effects were evaluated in 100 children who were referred to the Pediatric Neurology Clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran from April 2011 to March 2012, and were treated with 3 mg/kg/day of TPM for three months. Fifty eight (57.4%) girls and 42 (41.6%) boys with the mean age of 10.46±2.11 years were evaluated. Monthly frequency, severity, and duration of headache decreased with treatment from 15.34±7.28 to 6.07±3.16 attacks, from 6.21±1.74 to 3.15±2.22, and from 2.28±1.55 to 0.94±0.35 hours, respectively, and the Pediatric Migraine Disability Assessment score reduced with TPM from 32.48±9.33 to 15.54±6.16. Transient side-effects were seen in 21% of the patients, including hyperthermia in 11%, anorexia and weight loss in 6%, and drowsiness in 4%. No serious side-effects were reported. TPM could be considered as a safe and effective drug in pediatric migraine prophylaxis.

Frequency of subclinical hypothyroidism in 5- to 15-year-old children with migraine headache

Migraine is the most frequent acute recurrent primary headache in childhood. Hypothyroidism may be an exacerbating factor for some primary headaches. The purpose of this study was to determine the frequency of subclinical hypothyroidism in children with migraine headache. In a cross-sectional analytic study, the thyroid function tests of 5- to 15-year-old migraineurs who were referred to the Pediatric Neurology Clinic of Shahid Sadoughi University of Medical Sciences from January 2010 to February 2011 in Yazd, Iran, were measured based on the second edition of the International Classification of Headache Disorders. Forty-eight girls (46.2%) and 56 boys (53.8%) with mean age of 10.46±2.72 years were evaluated. Twenty-five (24%) children had hypothyroidism. The monthly frequency of headache (mean±SD, 14.75±8.9 vs. 20.12±9.49, p=0.04) and the duration of headache (mean±SD, 1.96±1.08 vs. 3.75±2.71 h, p=0.03) were more statistically significant in migraineur children with hypothyroidism, but the mean age, mean of onset age of migraine, sex distribution, and severity of headache were not statistically different in both groups. Based on the results of this study, subclinical hypothyroidism was as an exacerbating factor for migraine headache. Therefore, it is logical to check the thyroid function tests in migraineur children.

Subcutaneous delivery of sumatriptan in the treatment of migraine and primary headache

Subcutaneous sumatriptan is an effective treatment for pain from acute migraine headache, and can be used in patients with known migraine syndrome and in patients with primary headaches when secondary causes have been excluded. In limited comparative trials, subcutaneous sumatriptan performed in a manner comparable with oral eletriptan and intravenous metoclopramide, was superior to intravenous aspirin and intramuscular trimethobenzamide-diphenhydramine, and was inferior to intravenous prochlorperazine for pain relief. The most common side effects seen with subcutaneous sumatriptan are injection site reactions and triptan sensations. As with all triptans, there is a risk of rare cardiovascular events with subcutaneous sumatriptan and its use should be limited to those without known cerebrovascular disease and limited in those with known cardiovascular risk factors and unknown disease status. In studies of patient preference and tolerability, the subcutaneous formulation has a faster time of onset and high rate of efficacy when compared with the oral formulation, but the oral formulation appears to be better tolerated. It is important to consider the needs of the patient, their past medical history, and what aspects of migraine treatment are most important to the patient when considering treatment of acute migraine or primary headache. Subcutaneous sumatriptan is a good first-line agent for the treatment of pain from acute migraine headaches and primary headaches.

Treating Headache Recurrence After Emergency Department Discharge: A Randomized Controlled Trial of Naproxen Versus Sumatriptan

Multiple parenteral medications are used to treat migraine and other acute primary headaches in the emergency department (ED). Regardless of specific headache diagnosis, no medication eliminates the frequent recurrence of primary headache after ED discharge. It is uncertain which medication primary headache patients should be given on discharge from an ED. The aim of this study is to compare the efficacy of oral sumatriptan with naproxen for treatment of post-ED recurrent primary headache. This was a randomized, double-blind efficacy trial. We randomized patients to either naproxen 500 mg or sumatriptan 100 mg for headache recurrence after ED discharge. Patients were eligible if they received parenteral therapy for an acute exacerbation of a primary headache in the ED. Patients who met established criteria for migraine without aura were designated a priori as a homogenous subgroup of interest. We followed all patients by telephone 48 hours after ED discharge. The primary endpoint was the between-group difference in change in pain intensity during the 2-hour period after ingestion of either 500 mg naproxen or 100 mg sumatriptan. This difference was measured on a validated 11-point (0 to 10) verbal numeric rating scale (NRS). Satisfaction with the medication and adverse effects were also assessed. Patients who met criteria for migraine without aura were analyzed twice according to a priori design: once as a homogenous subgroup and then again combined with all other primary headaches. Of 410 patients randomized, 383 (93%) had outcome data available for analysis. Two hundred eighty (73%; 95% confidence interval [CI] 68% to 77%) reported headache post-ED discharge and 196 (51%; 95% CI 44% to 58%), including 88 with migraine, took the investigational medication provided to them. The naproxen group improved by a mean of 4.3 NRS points, whereas the sumatriptan group improved by 4.1 points (95% CI for difference of 0.2 points: -0.7 to 1.1 points). Findings were virtually identical among the migraine subset (4.3 versus 4.2 NRS points; 95% CI for difference of 0.1 points: -1.3 to 1.5 points). Seventy-one percent (95% CI 62% to 80%) of naproxen patients and 75% (95% CI 66% to 84%) of sumatriptan patients would want to take the same medication the next time. Adverse effect profiles were also comparable. In this trial, nearly three quarters of patients reported headache recurrence within 48 hours of ED discharge. Naproxen 500 mg and sumatriptan 100 mg taken orally relieve post-ED recurrent primary headache and migraine comparably. Clinicians should be guided by medication costs, contraindications, and a patient's previous experience with the medication.

Clinical features, diagnosis and treatment of acute primary headaches at an emergency center: why are we still neglecting the evidence?

In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.