Benign Headache Management in the Emergency Department

Brit J. Long, Alex Koyfman

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Headache is a common complaint managed in the emergency department (ED), with emergency physicians focusing on evaluation for life-threatening conditions while treating pain and nausea. Objective: This review evaluates the treatment of benign, primary headaches in the ED, with recommendations provided based on the literature. Discussion: Headaches are a major cause of disability in the United States and a common condition managed in the ED. The primary objectives of emergency evaluation of these patients include evaluation for a life-threatening, secondary cause of headache, with treatment of primary headaches. Close evaluation for a secondary cause of headache include consideration of red flags and focused neurologic examination. The diagnosis of primary headaches is clinical. Literature has evaluated medication efficacy in headache treatment, with antidopaminergic medications demonstrating high rates of efficacy when used in combination with nonsteroidal inflammatory drugs or acetaminophen. Dexamethasone can be used for the reduction of headache recurrence. If dehydration is present, intravenous fluids should be provided. Diphenhydramine is not recommended for analgesia but may reduce akathisia associated with prochlorperazine. Ketamine, propofol, and nerve blocks demonstrate promise. Triptan agents are also efficacious, provided absence of contraindications. Most patients are appropriate for discharge with pain improvement. Conclusions: A variety of medications is available for the treatment of primary headaches in the ED. Antidopaminergic agents demonstrate the highest efficacy and should be provided with acetaminophen and nonsteroidal inflammatory drugs. Dexamethasone may reduce headache recurrence. Other treatments include ketamine, propofol, and nerve blocks.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Headache
Hospital Emergency Service
Nerve Block
Ketamine
Propofol
Acetaminophen
Dexamethasone
Emergencies
Prochlorperazine
Tryptamines
Therapeutics
Diphenhydramine
Recurrence
Pain
Psychomotor Agitation
Patient Discharge
Neurologic Examination
Dehydration
Pharmaceutical Preparations
Analgesia

Keywords

  • Cluster
  • Headache
  • Medication
  • Migraine
  • Primary
  • Tension
  • Therapy

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Benign Headache Management in the Emergency Department. / Long, Brit J.; Koyfman, Alex.

In: Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

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