Presentation of Headache in the Emergency Department and its Triage

Four million patients present to US emergency departments (EDs) annually with the complaint of headache. The emergency physician must diagnose malignant secondary causes of headache such as aneurysmal subarachnoid hemorrhage expeditiously, treat acute exacerbations of primary headache disorders such as migraine effectively, and provide tailored education to the primary headache patients who use the ED as a medical safety net. The needs of patients who present to EDs are varying and complex - a one-size-fits-all strategy is doomed to failure. Herein, we discuss clinical features of the various secondary headaches that emergency physicians encounter commonly; efficient diagnostic work-ups, including when to order laboratory and imaging tests; and strategies for effective parenteral and post-discharge treatment. The chapter also discusses management strategies for the complicated subgroup of ED patients with comorbid psychiatric illness, medication overuse headache, and opioid dependence who make frequent visits to an ED for management of headache.