Headache in the emergency department

Headache is the fourth most common reason for adult patients to present to the emergency department. Approximately two-thirds of these visits are for primary headache disorders, such as migraine, cluster, and tensiontype headache. When evaluating a patient with headache in the emergency department, the physician must first decide if the headache represents a primary headache disorder or whether there is some other underlying etiology. Once a serious cause for headache has been excluded, the physician can focus on pain management. The first half of this chapter discusses the differential and diagnostic work-up of headaches with potentially dangerous etiologies. The last half addresses management strategies for primary headache disorders, with special focus on prolonged and intractable migraine headaches.