Emergency department evaluation of headache

Although headache is a common complaint in the ED, it is often considered to be more of a nuisance than a true medical emergency. It is imperative for the physician evaluating patients in the emergency setting to have a good understanding of the many disorders that may have headache as a feature. It is of utmost important to first identify or eliminate the secondary causes of headache through history taking and physical examinations as described in this chapter. If a secondary cause of headache is identified, appropriate steps aimed at treating the underlying illness must be addressed. If the presenting complaint is the result of a primary headache disorder, treatment options as described here should be employed, and referrals for follow-up care should be given to avoid repeated ED visits. Although, the majority of patients presenting to the ED suffer from an acute exacerbation of one of the primary headache disorders, care must be taken to rule out more serious causes of headache, especially in patients who have new or unusual symptoms. Diagnosis should always be established before initiation of therapy.