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HWN Suggests

Treating Headaches Doesn’t Have to Cause One

A headache is one of the common presentations in the emergency department. Of course, the vast majority of them are no big deal. Still, they could be deadly, so be vigilant. Just not so vigilant you order unnecessary imaging. But, obviously, don’t skip a scan that could miss a diagnostic clue of dangerous secondary causes. Also, patients need immediate and effective pain relief. Not opioids, though.

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 I Can’t Get You Out of my Head – Headache at St Emlyns

Many patients presenting to the ED with a primary presenting of feature of headache will have serious pathology. In Virchester audits the number with serious disease (tumour, bleeding, meningitis etc.) has remained at about 10% for many years. Our job as emergency physicians is to identify those with life threatening disease and also to help those with lesser disease burden, but who may still require care. Key to this is actively ruling out the life-threatening and life-changing diagnoses...

 No, it’s not a Migraine

This is not an academic review on headaches, but rather an attempt to bring awareness to a condition often unrecognized and misdiagnosed, and therefore untreated. Occipital Neuralgia (ON) is a type of head pain that offers a great combination of easy diagnosis, and effective and rewarding treatment.

 Red Flag Headaches: General Approach and Cervical Artery Dissections

The big five commonly missed emergency causes of headaches that cannot routinely be ruled out on plain CT/LP include: Cervical artery dissection, CVT, Idiopathic Intracranial Hypertension, CO poisoning, Giant cell arteritis.

 Risk Assessment: High-Risk Headache in the Emergency Department

After a CT scan demonstrates no visible hemorrhage, the risk of a subarachnoid hemorrhage was 1 in 200.

Articles of Interest

Post Lumbar Puncture Headaches

Early ambulation, NOT laying flat post procedure. ost lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms.

Acute Headache in the Emergency Department

Although there are many sub-populations to be cognizant of when presented with the chief complaint of headache (elderly, pregnant women/postpartum, coagulopathic patients, those with subacute/subtle trauma, cancer patients), the immunosuppressed and particularly HIV-positive patients require special consideration.

Headache in the Emergency Department: 13 Dangerous Causes

Emergency clinicians do not rule in migraine or other benign causes of headache. unless the headache is congruent to an established pattern for that patient, the history and physical specifically targets these 13 conditions.

Headache Management in the ED

Primary headaches are not life-threatening, but they can cause significant morbidity. These headaches include tension, migraine, cluster, paroxysmal hemicranias, hemicrania continua, trigeminal neuralgia, and medication overuse. Secondary headaches are dangerous and may result in death if not diagnosed and treated.

How to diagnose and treat benign headaches

Benign headaches are recurrent, common neurological conditions in the ED. Most patients with acute benign headaches can be treated symptomatically and discharged from the ED after appropriate care without advanced investigations.

Management Strategies For Acute Headache In The Emergency Department

While emergency management focuses on identification and treatment of life-threatening causes of headache, such as subarachnoid hemorrhage (SAH) or bacterial meningitis, there is a tendency to misdiagnose specific primary headache disorders and fail to provide consistent, effective treatments in accordance with published guidelines.

Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection

10 serious causes of headache to consider for every ED patient with headache...

Targeted Management of Headaches for Emergency Physicians

Headaches are one of the most prevalent and disabling categories of disorders worldwide. Emergency healthcare providers are in a unique position to provide management of acute attacks, exclude emergent causes, educate patients, initiate some forms of preventive treatment, refer patients for appropriate outpatient workup and management of chronic headaches, and clarify and provide feedback regarding diagnostic criteria.

Resources

SAEM

Of headache that are classified as primary, a large majority (nearly 90%) are migraine, tension or cluster headache. The exact pathophysiology of these types of headache is poorly understood.