- Only approximately 5% of all headaches that present in the ED are true emergencies
- After evaluating for potential emergencies and performing a full neuro exam, pause and consider if any of the following Red Flags are present:
To diagnose migraine, need 5 separate episodes of headache characterized by:
"Migraine” or undifferentiated benign headache, you can treat the same way in the ED
Best evidence for acute headache treatment includes the following:
Avoid narcotics and barbiturates out of concern for dependency and rebound effect
- After evaluating for potential emergencies and performing a full neuro exam, pause and consider if any of the following Red Flags are present:
- First or worst
- Neuro abnormalities
- Associated symptoms
- Persistent location/time of day
- Unresponsive to treatment
- Cancer, HIV, Trauma
- Change in pattern, frequency, severity
To diagnose migraine, need 5 separate episodes of headache characterized by:
- 4 - 72 hours in length
- Unilateral
- Pulsating
- Moderate or severe
- Aggravated by routine activity
- With nausea/vomiting and/or photophobia/phonophobia
"Migraine” or undifferentiated benign headache, you can treat the same way in the ED
Best evidence for acute headache treatment includes the following:
- Dark and quiet room
- 1L Crystalloid
- 10mg IV or PO Reglan (or Compazine)
- 25mg IV or PO Benadryl +/-
- 30mg IV Toradol OR 550mg PO Naproxen OR 600mg PO Ibuprofen
- Consider 10mg IV Decadron to prevent short term headache recurrence
Avoid narcotics and barbiturates out of concern for dependency and rebound effect