Key Chapter Points

Possible secondary headaches need to be considered initially for all patients presenting to the ED with acute headache (see Chap.  2 for assessment strategies). Always consider trauma as a possible cause of acute headache. Brain injury severity, demographic features, and examination findings help determine the need for additional testing in patients with headache after trauma. Headache due to arterial dissection in the neck may occur after seemingly insignificant neck trauma (e.g., whiplash injury, spinal manipulation, or prolonged abnormal posture). Meningitis may be considered in patients with nontraumatic headache plus fever, neck stiffness, or altered mental status. Idiopathic intracranial hypertension may be considered in obese females with headache, transient visual loss, and papilledema. Imaging studies will fail to show intracranial mass lesions in these patients. Thunderclap headaches must always be evaluated fully before the diagnosis of primary thunderclap headache is assigned.


Carotid dissection Concussion Meningitis Idiopathic intracranial hypertension Thunderclap headache Trauma 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of PittsburghPittsburghUSA
  2. 2.Dean Health SystemsMadisonUSA

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