APPROACH TO HEADACHE IN THE ER

Introduction: Acute severe headache is always serious and demands care and usually patients present to to the emergency department (ED). There are many medications available, and many hazards to be avoided, both regarding the diagnosis and the management. It represents an agonizingly painful and disturbing event for the patients, families, as well as the medical team. Usually, these patients have done many methods with expert doctors to no benefit. Inpatient assessment and management could be helpful in some patients. The major diagnostic difficulties in diagnosing the cases of severe acute headache in the ED are misdiagnosis of primary headache syndromes and undiagnosed secondary causes of headache. Missing the correct diagnosis will decrease the chances of correct management. Red flags such as meningismus, fever, neurologic signs, and concurrent medical illnesses should raise the attention. Aim of work: In this review, we will discuss the most recent evidence regarding the recent approach to the emergency management of patients with headache. We will also discuss options for the management. Methodology: We did a systematic search for approach to headache in the emergency department using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). We only included full articles. Conclusions: Most cases of headache are evaluated in EDs have migraine, however some of them have other primary and secondary headache disorders that must be excluded. When this is performed, many medications are available to relief of headache, involving parenteral ketorolac, neuroleptic antiemetics, DHE, triptans, and magnesium sulfate. Opioids, while commonly employed, are generally less useful, and may lead to readmission to the ED. Even though most chronic headache problems could be treated in the outpatient setting, inpatient management can offer many benefits, especially in patients who are overusing medications. Intravenous DHE has good evidence for efficacy. Few commonly proposed managements plans for acute headache relief in the ED have been studied in that setting; similarly, most inpatient IV treatment protocols are not clearly established to be effective. Problems to further research include lack of funding and individual differences between refractory headache patients, making comparison studies difficult. Key words: Headache, emergency department, management