Skip to main content
SpringerLink
Log in
Book cover

Practical Assessment and Treatment of the Patient with Headaches in the Emergency Department and Urgent Care Clinic pp 21–52Cite as

Getting Started

  • Chapter
  • First Online:

Key Chapter Points

Headaches caused by readily identifiable, underlying conditions (e.g., trauma, meningitis, subarachnoid hemorrhage, etc.) are called secondary headaches. Primary headaches are headaches without a readily identifiable, underlying medical condition (e.g., migraine, tension-type, and cluster headaches). ED headache diagnosis should focus on differentiating primary from secondary headache, rather than determining a specific primary headache diagnosis. Six essential questions can help determine why patients are presenting to the ED and whether they are likely to have a secondary headache. An effective, focused screening neurological examination can generally be performed in about 5 minutes. Imaging studies are usually unnecessary for patients with chronic headaches without alarm signs or symptoms. Patients >50 years old with a new headache should be screened for giant cell arteritis. Other causes, such as primary and metastatic cancers may also need to be considered.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Friedman BW, Hochberg ML, Esses D, et al. Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Ann Emerg Med. 2007;49:409–19.

    Article  PubMed  Google Scholar 

  2. Breen DP, Duncan CW, Pope AE, Gray AJ, Salman RA. Emergency department evaluation of sudden severe headache. Q J Med. 2008;101:435–43.

    CAS  Google Scholar 

  3. Matharu MS, Schwedt TJ, Dodick DW. Thunderclap headache: an approach to a neurologic emergency. Curr Neruol Neurosci Rep. 2007;7:101–9.

    Article  CAS  Google Scholar 

  4. Eross E, Dodick D, Eross M. The sinus, allergy, migraine study. Headache. 2007;47:213–24.

    Article  PubMed  Google Scholar 

  5. Obermann M, Yoon MS, Dommes P, et al. Prevalence of trigeminal autonomic symptoms in migraine: a population-based study. Cephalalgia. 2007;27:504–9.

    Article  PubMed  CAS  Google Scholar 

  6. Schreiber CP, Hutchinson S, Webster CJ, et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. Arch Intern Med. 2004;164:1769–72.

    Article  PubMed  Google Scholar 

  7. Lipton RB, Dodick D, Sadovsky R, et al. A self-administered screener for migraine in primary care: the ID Migraine™ validation study. Neurology. 2003;61:375–82.

    PubMed  CAS  Google Scholar 

  8. Mostardini C, d’Agostino VC, Dugoni DE, Cerbo R. A possible role of ID-Migraine in the emergency department: study of an emergency department out-patient population. Cephalalgia. 2009;29:1326–30.

    Article  PubMed  CAS  Google Scholar 

  9. Bigal ME, Ashina S, Burstein R, et al. Prevalence and characteristics of allodynia in headache sufferers: a population study. Neurology. 2008;70:1525–33.

    Article  PubMed  CAS  Google Scholar 

  10. Tietjen GE, Brandes JL, Peterlin BL, et al. Allodynia in migraine: association with comorbid pain conditions. Headache. 2009;49:1333–44.

    Article  PubMed  Google Scholar 

  11. Lovati C, D’Amico D, Bertora P. Allodynia in migraine: frequent random association or unavoidable consequence? Exp Rev Neurother. 2009;9:395–408.

    Article  Google Scholar 

  12. Madden T, Rosen N, Young W. Exploring home allodynia testing for future clinical and scientific uses. Headache. 2009;49:132–4.

    Article  PubMed  Google Scholar 

  13. Friedman B, Bijur P, Greenwalk P, Lipton R, Gallagher EJ. Clinical significance of brush allodynia in emergency patients with migraine. Headache. 2009;49:31–5.

    Article  PubMed  Google Scholar 

  14. Burstein R, Jakubowski M. Analgesic triptan action in an animal model of intracranial pain: a race against the development of central sensitization. Ann Neurol. 2004;55:27–36.

    Article  PubMed  CAS  Google Scholar 

  15. Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: a race against the development of cutaneous allodynia. Ann Neurol. 2004;55:19–26.

    Article  PubMed  CAS  Google Scholar 

  16. Cady RK, Freitag FG, Mathew NT, et al. Allodynia-associated symptoms, pain intensity and time to treatment: predicting treatment response in acute migraine intervention. Headache. 2009;49:350–63.

    Article  PubMed  Google Scholar 

  17. Schoenen J, De Klippel N, Giurgea S, et al. Almotriptan and its combination with aceclofenac for migraine attacks: a study of efficacy and the influence of auto-evaluated brush allodynia. Cephalalgia. 2008;28:1095–105.

    Article  PubMed  CAS  Google Scholar 

  18. Kalita J, Yadav RK, Misra UK. A comparison of migraine patients with and without allodynic symptoms. Clin J Pain. 2009;25:696–8.

    Article  PubMed  Google Scholar 

  19. Pozo-Rosich P, Oshinsky ML. Dihydroergotamine (DHE) blocks the induction of central sensitization in the trigeminal nucleus caudalis [abstract]. Neurology. 2005;64:A151.

    Google Scholar 

  20. Silberstein SD, Young WB, Hopkins MM, et al. Dihydroergotamine for early and late treatment of migraine with cutaneous allodynia: an open-label pilot trial. Headache. 2007;47:878–85.

    Article  PubMed  Google Scholar 

  21. Ibañez J, Arikan F, Pedraza S, et al. Reliability of clinical guidelines in the detection of patients at risk following mild head injury: results of a prospective study. J Neurosurg. 2004;100:825–34.

    Article  PubMed  Google Scholar 

  22. Saboori M, Ahmadi J, Farajzadegan Z. Indications for brain CT scan in patients with minor head injury. Clin Neurol Neurosurg. 2007;109:399–405.

    Article  PubMed  Google Scholar 

  23. Holm L, Cassidy JD, Carroll LJ, Borg J. Summary of the WHO Collaborating Centre for neurotrauma task force on mild traumatic brain injury. J Rehabil Med. 2005;27:137–41.

    Article  Google Scholar 

  24. Hylleraas S, Davidsen EM, Benth JS, Gulbrandsen P, Dietrichs E. The usefulness of testing head and neck muscle tenderness and neck mobility in acute headache patients. Funct Neurol. 2010;25:27–31.

    PubMed  Google Scholar 

  25. Barbanti P, Aurilia C, Egeo G, Fofi L. Hypertension as a risk factor for migraine chronification. Neurol Sci. 2010;31 Suppl 1:S41–3.

    Article  PubMed  Google Scholar 

  26. Gippono S, Venturelli E, Rao R, Liberini P, Padovani A. Hypertension is a factor associated with chronic daily headache. Neurol Sci. 2010;31 Suppl 1:S171–3.

    Article  Google Scholar 

  27. Friedman BW, Grosberg BM. Diagnosis and management of the primary headache disorders in the emergency department setting. Emerg Med Clin N Am. 2009;27:71.

    Article  Google Scholar 

  28. Stewart WF, Wood C, Reed ML, et al. Cumulative lifetime migraine incidence in women and men. Cephalalgia. 2008;28:1170–8.

    Article  PubMed  CAS  Google Scholar 

  29. Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. American College of Emergency Physician. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008;52:407–36.

    Article  PubMed  Google Scholar 

  30. Gore DR. Roentgenographic findings in the cervical spine in asymptomatic persons. A ten-year follow-up. Spine. 2001;26:2463–6.

    Article  PubMed  CAS  Google Scholar 

  31. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 1986;11(6):521–4.

    Article  PubMed  CAS  Google Scholar 

  32. Wilbrink LA, Perrari MD, Kruit MC, Haan J. Neuroimaging in trigeminal autonomic cephalalgias: when, how, and of what? Curr Opin Neurol. 2009;22:247–53.

    Article  PubMed  Google Scholar 

  33. Roos KL. Lumbar puncture. Semin Neurol. 2003;23:105–14.

    Article  PubMed  Google Scholar 

  34. Buruma OJ, Janson HL, Den Bergh FA, Bots GT. Bloodstained cerebrospinal fluid: traumatic puncture or haemorrhage? J Neurol Neurosurg Psychiatry. 1981;44:144–7.

    Article  PubMed  CAS  Google Scholar 

  35. Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008;52:407–36.

    Article  PubMed  Google Scholar 

  36. Edlow JA, Malek AM, Ogilvy CS. Aneurysmal subarachnoid hemorrhage: update for emergency physicians. J Emerg Med. 2008;34:237–51.

    Article  PubMed  Google Scholar 

  37. Ju YS, Schwedt TJ. Abrupt-onset severe headaches. Semin Neurol. 2010;30:192–200.

    Article  PubMed  Google Scholar 

  38. Perry JJ, Spacke A, Forbes M, et al. Is the combination of negative computed tomography result and negative lumbar puncture result sufficient to rule out subarachnoid hemorrhage? Ann Emerg Med. 2008;51:707–13.

    Article  PubMed  Google Scholar 

  39. Parikh M, Miller NR, Lee AG, et al. Prevalence of a normal C-reactive protein with an elevated erythrocyte sedimentation rate in biopsy-proven giant cell arteritis. Ophthalmology. 2006;113:1842–5.

    Article  PubMed  Google Scholar 

  40. Bezov D, Ashina S, Lipton R. Post-dural puncture headache: part I. Diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50:1144–52.

    Article  PubMed  Google Scholar 

  41. Bezov D, Ashina S, Lipton R. Post-dural puncture headache: part II. Prevention, management, and prognosis. Headache. 2010;50:1482–98.

    Article  PubMed  Google Scholar 

  42. Strauss SE, Thorpe KE, Holroyd-Leduc J. How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA. 2006;296:2012–22.

    Article  Google Scholar 

  43. Miller A, Green M, Robinson D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (Clin Res Ed). 1983;286:266.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA

    Dawn A. Marcus MD (Professor)

  2. Dean Health Systems, Madison, WI, USA

    Philip A. Bain MD

Authors
  1. Dawn A. Marcus MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip A. Bain MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dawn A. Marcus MD .

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Marcus, D.A., Bain, P.A. (2012). Getting Started. In: Practical Assessment and Treatment of the Patient with Headaches in the Emergency Department and Urgent Care Clinic. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0002-8_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-0002-8_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-0001-1

  • Online ISBN: 978-1-4614-0002-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation