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Acute Headache in the Emergency Department

  • Dominique Valade
  • Anne Ducros
  • Susan W. Broner
Reference work entry

Abstract

In emergency departments, the top priority is to establish a precise etiologic diagnosis and to classify the headache as a primary headache, a benign secondary headache, such as from influenza, or a secondary headache due to a serious condition, requiring further exploration or emergency treatment (meningeal hemorrhage, meningitis, intracranial hypertension, amongst others). The crucial part of this diagnostic step is the interview. This step, supplemented by the clinical examination, will determine the differential diagnosis and, ultimately, will steer any tests that need to be done emergently and the course of treatment. Depending on the headache diagnosis, the patient may be treated and released for outpatient follow-up or may need to be admitted to the hospital for either further evaluation and/or treatment.

The physician must also identify headaches occurring in patients already hospitalized for another reason. It is important to rule out any iatrogenic causes such as drug induced headaches or headaches caused by hypotension of the cerebral spinal fluid (CSF) such as secondary to a persisting fistula after lumbar puncture or other procedure that enters into the CSF space.

Finally, some patients diagnosed with a primary headache may sometimes require hospitalization either because of an acute exacerbation of their primary headache in a particular psychological context, or, especially, for detoxification for chronic daily headache associated with medication overuse.

Keywords

Cluster Headache Lumbar Puncture Intracranial Hypertension Cerebral Spinal Fluid Medication Overuse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  • Dominique Valade
    • 1
  • Anne Ducros
    • 2
  • Susan W. Broner
    • 3
  1. 1.Emergency Headache CenterLariboisière Hospital, Assistance Publique des Hôpitaux de ParisParisFrance
  2. 2.Centre Urgences CéphaléesAssistance Publique des Hôpitaux de Paris, Head and Neck Clinic, Hôpital LariboisièreParisFrance
  3. 3.The Headache InstituteSt. Luke's-Roosevelt HospitalNew YorkUSA

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