Headache, Emergency Medicine

Josh W. Joseph Reviewed 06/2017
 


Basics

Description

  • Pain in the cranium, orbits, or upper neck

  • Pain within the skull is projected to the surface:

    • Intracranial:

      • Arteries, veins, dura, meninges

    • Extracranial:

      • Skin, scalp, fascia, muscles

      • Mucos...

Diagnosis

Signs and Symptoms

History

  • Attributes of the pain—PQRST:

    • Provocative and palliative features:

      • Position of the head, coughing or straining (increase suggests elevated ICP), and movement

    • Quality:

      • Th...

Treatment

Initial Stabilization/Therapy

  • ABCs if altered mental status

  • Empiric antibiotics if bacterial meningitis is suspected, acyclovir if immunocompromised

Ed Treatment/Procedures

Follow-Up

Disposition

Admission Criteria

  • Headache secondary to suspected organic disease

  • Intractable vomiting and dehydration

  • Pain refractory to outpatient management

  • Consider ICU admission:

    • Suspected sympt...

Treatment

Medication

Pearls and Pitfalls

  • The sensitivity for detecting SAH on CT scan falls rapidly after 24 hr. LP remains essential for all patients with suspected SAH presenting after 6 hr of symptom onset.

  • Neurology co...

Additional Reading

  • Edlow  JA, Caplan  LR, O’Brien  K, et al. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol.  2013;12:175–185.

  • Perry  JJ, Stiell  IG, ...

Codes

ICD9

  • 339.00 Cluster headache syndrome, unspecified

  • 346.90 Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus

  • 784.0 Headache

  • 339.00 Cluster headache ...

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