Advertisement

Headache in the Emergency

  • Aastha Takkar Kapila
  • Sudhir Sharma
  • Vivek Lal
Chapter

Abstract

Headache is by far the most common usual neurological complaint in general population. Given the spectrum of benign etiology to a life-threatening illness, it is a highly challenging symptom for a clinician in an emergency department (ED). The primary objective of the emergency clinician is often to determine whether the patient has a secondary headache attributed to an urgent medical condition requiring prompt therapy. In a busy emergency, it can be intimidating where a patient of severe tension-type headache presents with as severe a distress as a patient with subarachnoid hemorrhage. This may result in a tendency to over investigate with neuroimaging and additional lab investigations. These not only impose significant impacts on the patient’s quality of life and healthcare economy but also cause unnecessary delays in appropriate treatment. In most instances, the clinician can accurately diagnose a patient’s headache from history and careful clinical examination and determine whether neuroimaging or additional lab testing is indicated

References

  1. 1.
    Srivastava SS, Desai P, Zheng L. Analysis of headache management in a busy emergency room in the United States. Headache. 2008;48:931–8.CrossRefGoogle Scholar
  2. 2.
    Morgensten LB, Huber JC, Luna-Gonzales H, Saldin KR, Shaw SG, Knudson L, et al. Headache in the emergency department. Headache. 2001;41:537–41.CrossRefGoogle Scholar
  3. 3.
    Ramirez-Lassepas M, Espinosa CE, Cicero JJ, Johnston KL, Cipolle RJ, Berber DL. Predictors of intracranial pathologic findings in patient who seek emergency care because of headache. Arch Neurol. 1997;54:1506–9.CrossRefGoogle Scholar
  4. 4.
    Barton C. Evaluation and treatment of headache patients in the emergency department: A survey. Headache. 1993;34:91–4.CrossRefGoogle Scholar
  5. 5.
    Goldstein JN, Camargo CA Jr, Pelletier AJ, Edlow JA. Headache in United States emergency departments: demographics, work-up, and frequency of pathological diagnoses. Cephalalgia. 2006;26:684–90.CrossRefGoogle Scholar
  6. 6.
    Cerbo R, Villani V, Bruti G, Di Stani F, Mostardini C. Primary headache in emergency department: prevalence, clinical features and therapeutical approach. J Headache Pain. 2005;6:287–9.CrossRefGoogle Scholar
  7. 7.
    Rassmussen BK. Epidemiology of headache. Cephalalgia. 1995;15:45–68.CrossRefGoogle Scholar
  8. 8.
    Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.CrossRefGoogle Scholar
  9. 9.
    Cortelli P, Cevoli S. Evidence-based diagnosis of nontraumatic headache in the emergency department: a consensus statement on four clinical scenarios. Headache. 2004;44:587–95.CrossRefGoogle Scholar
  10. 10.
    Clinch CR. Evaluation of acute headache in adults. Am Fam Physician. 2001;63:685–92.PubMedGoogle Scholar
  11. 11.
    Ward TN, Levin M, Phillips JM. Evaluation and management of headache in the emergency department. Med Clin N Am. 2001;4:971–85.CrossRefGoogle Scholar
  12. 12.
    Bono G, Antonaci F, Mancioli A, Guaschino E, Minonzio G, Mauri M. The management of headaches in the emergency department: critical issues. Neurol Sci. 2006;27:S59–61.CrossRefGoogle Scholar
  13. 13.
    Breen DP, Duncan CW, Pope AE, Gray AJ, Al-Shahi Salman R. Emergency department evaluation of sudden, severe headache. QJM. 2008;101:435–43.CrossRefGoogle Scholar
  14. 14.
    Mert E, Ozge A, Tasdelen B, Yilmaz A, Bilgin NG. What clues are available for differential diagnosis of headaches in emergency settings? J Headache Pain. 2008;9:89–97.CrossRefGoogle Scholar
  15. 15.
    Matharu MS, Schwedt TJ. DodickDW Thunderclap headache: an approach to a neurologic emergency. Curr Neurol Neurosci Rep. 2007;7:101–9.CrossRefGoogle Scholar
  16. 16.
    Valade D. Headache presenting to a casualty service: four year experience at an Emergency Headache Center. Rev Neurol (Paris). 2005;161:729–31.CrossRefGoogle Scholar
  17. 17.
    Dhopesh V, Anwar R, Herring C. A retrospective assessment of emergency department patients with complaint of headache. Headache. 1979;19:37–42.CrossRefGoogle Scholar
  18. 18.
    Newman LC, Lipton RB. Emergency department evaluation of headache. Neurol Clin. 1998;16:285–303.CrossRefGoogle Scholar
  19. 19.
    Marks DR, Rapoport AM. Practical evaluation and diagnosis of headache. Semin Neurol. 1997;17:307–12.CrossRefGoogle Scholar
  20. 20.
    Stevenson RJ, Dutta D, MacWalter RS. The management of acute headache in adults in an acute admissions unit. Scott Med J. 1998;43:173–6.CrossRefGoogle Scholar
  21. 21.
    Ducros A, Bousser MG. Thunderclap headache. BMJ. 2012;345:e8557.  https://doi.org/10.1136/bmj.e8557.CrossRefGoogle Scholar
  22. 22.
    Holle D, Oberman M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disord. 2013;6(6):369–74.CrossRefGoogle Scholar
  23. 23.
    Evans RW. Diagnostic testing for headache. Med Clin North Am. 2001;85(4):865–85.CrossRefGoogle Scholar
  24. 24.
    Zehtabchi S, Wright B. Does this emergency department patient with headache require neuroimaging? Ann Emerg Med. 2008;51:324–7.CrossRefGoogle Scholar
  25. 25.
    Edlow JA, Caplan LR. Avoiding pitfalls in diagnosis of subarachnoid hemorrhage. NEJM. 2000;342:39–6.CrossRefGoogle Scholar
  26. 26.
    American Academy of Neurology. Practice parameter: The electroencephalogram in the evaluation of headache. Neurology. 1995;45:1411–3.CrossRefGoogle Scholar
  27. 27.
    Cortelli P, Cevoli S, Nonino F, Baronciani D, Magrini N, Re G, et al. Evidence-based diagnosis of nontraumatic headache in the emergency department: a consensus statement on four clinical scenarios. Headache. 2004;44:587–95.CrossRefGoogle Scholar
  28. 28.
    American College of Emergency Physician (ACEP). Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache. Ann Emerg Med. 2002;39:108–22.CrossRefGoogle Scholar
  29. 29.
    Orr SL, Friedman BW, Christie S, Minen MT, Bamford C, Kelley NE, et al. Management of adults with acute migraine in the emergency department: the American headache society evidence assessment of parenteral pharmacotherapies. Headache. 2016;56:911–40.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Aastha Takkar Kapila
    • 1
  • Sudhir Sharma
    • 2
  • Vivek Lal
    • 1
  1. 1.Department of NeurologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of Neurology, Indira Gandhi Medical College (IGMC)SimlaIndia

Personalised recommendations