Headache - Revision history

Danbot: Expand Disposition with actionable admit/discharge criteria

2026-03-22T09:40:29Z

Expand Disposition with actionable admit/discharge criteria

← Revisión anterior		Revisión del 09:40 22 mar 2026
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	==Disposition==		==Disposition==
	*Outpatient referral to ~~primary care or~~ neurology for recurrent, recalcitrant headaches		*Discharge if:
	*Admission for status migrainosus or dangerous underlying etiology		**Identified benign etiology with symptom improvement after treatment
			**Normal neurologic exam
			**No red flag features (thunderclap, worst headache, focal deficits, fever, immunocompromised)
			**Able to tolerate oral intake
			**Reliable follow-up
			*Admit for:
			**Dangerous secondary cause identified (SAH, meningitis, mass lesion, venous sinus thrombosis)
			**Status migrainosus refractory to ED treatment
			**Persistent neurologic deficits
			**Inability to tolerate oral medications despite treatment
			*Outpatient referral to neurology for recurrent or recalcitrant headaches


	==See Also==		==See Also==

Ostermayer at 15:53, 15 January 2026

2026-01-15T15:53:46Z

← Revisión anterior		Revisión del 15:53 15 ene 2026
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	{{~~Adult top}} [[~~headache (peds)]]		{{AdultPage\|headache (peds)}}
	==Background==		==Background==
	*Headache accounts for ~2.2% of all ED visits<ref>Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct;52(4):407-36. doi: 10.1016/j.annemergmed.2008.07.001.</ref>		*Headache accounts for ~2.2% of all ED visits<ref>Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct;52(4):407-36. doi: 10.1016/j.annemergmed.2008.07.001.</ref>

Rossdonaldson1: /* Video */

2024-04-17T20:13:15Z

Video

← Revisión anterior		Revisión del 20:13 17 abr 2024
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	*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]		*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]
	*[https://www.acep.org/patient-care/clinical-policies/headache/ ACEP Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache]		*[https://www.acep.org/patient-care/clinical-policies/headache/ ACEP Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache]

	~~==Video==~~
	~~{{#widget:YouTube\|id=jvMb84pH550}}~~

	==References==		==References==

Cmb23: /* Imaging */

2023-12-22T16:46:50Z

Imaging

← Revisión anterior		Revisión del 16:46 22 dic 2023
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	*Consider [[CXR]]		*Consider [[CXR]]
	**50% of patients with pneumococcal [[meningitis]] have evidence of [[pneumonia]] on CXR		**50% of patients with pneumococcal [[meningitis]] have evidence of [[pneumonia]] on CXR
			*Can rule out SAH for thunderclap headache if non-contrast head CT is negative and obtained within 6 hours of symptom onset. If further testing is needed after a negative head CT, can consider CTA, which is sensitive at detecting aneurysms >3mm <ref> Raam R, Tabatabai RR. Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes, An Update. Emerg Med Clin North Am. 2021 Feb;39(1):67-85. doi: 10.1016/j.emc.2020.09.004. PMID: 33218663. </ref> versus LP based on shared decision making
	*Consider CTA head and neck for headaches associated with head/neck trauma or neuro deficits		*Consider CTA head and neck for headaches associated with head/neck trauma or neuro deficits
	*Consider [[Brain MRI]] for red flag symptoms with a negative CT head		*Consider [[Brain MRI]] for red flag symptoms with a negative CT head

Patricklin at 17:13, 6 October 2023

2023-10-06T17:13:33Z

← Revisión anterior		Revisión del 17:13 6 oct 2023
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	*Headache accounts for ~2.2% of all ED visits<ref>Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct;52(4):407-36. doi: 10.1016/j.annemergmed.2008.07.001.</ref>		*Headache accounts for ~2.2% of all ED visits<ref>Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct;52(4):407-36. doi: 10.1016/j.annemergmed.2008.07.001.</ref>
	*The majority of these have a benign cause, but serious causes can be devastating, and a thorough H&P with an eye toward "red flag" symptoms is important in ED evaluation.		*The majority of these have a benign cause, but serious causes can be devastating, and a thorough H&P with an eye toward "red flag" symptoms is important in ED evaluation.
			*When red flags are excluded, may attempt to define a common primary headache syndrome, but this is not an ED priority
			**[[Migraine headache]]
			**[[Tension headache]]
			**[[Cluster headache]]

	{{HA red flags}}		{{HA red flags}}
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	**Orbital - [[Optic neuritis]], [[cavernous sinus thrombosis]]		**Orbital - [[Optic neuritis]], [[cavernous sinus thrombosis]]
	**Facial - [[Sinusitis]], [[carotid artery dissection]]		**Facial - [[Sinusitis]], [[carotid artery dissection]]
	*Prior headache history		*Triggers, auras, visual change, neuro symptoms, or systemic symptoms
			*Medication over-use, caffeine use, substance use, blood thinner uses
			*Prior headache history and any specialists seen
			**New-onset headache is generally more concerning

	===Physical Exam===		===Physical Exam===
	*Scalp and temporal artery palpation		*Scalp and temporal artery palpation
			*[[Neuro exam]]
			*HEENT and dental exam
			*Evaluate for meningismus
	*Sinus tap / transillumination		*Sinus tap / transillumination
	*[[EBQ: Jolt Test]]		*[[EBQ: Jolt Test]]
	*[[Neuro exam]]
	{{Jolt Test}}		{{Jolt Test}}

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	*Consider [[CXR]]		*Consider [[CXR]]
	**50% of patients with pneumococcal [[meningitis]] have evidence of [[pneumonia]] on CXR		**50% of patients with pneumococcal [[meningitis]] have evidence of [[pneumonia]] on CXR
			*Consider CTA head and neck for headaches associated with head/neck trauma or neuro deficits
			*Consider [[Brain MRI]] for red flag symptoms with a negative CT head
			*Consider MRV to evaluate for [[cerebral venous thrombosis]] for headache in the setting of hypercoagulability

	==Management==		==Management==

Elcatracho: /* External Links */

2021-01-13T17:15:22Z

External Links

← Revisión anterior		Revisión del 17:15 13 ene 2021
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	==External Links==		==External Links==
	*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]		*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]
	*[https://www.acep.org/patient-care/clinical-policies/headache/ ACEP Clinical Policy: Critical Issues in the Evaluation and		*[https://www.acep.org/patient-care/clinical-policies/headache/ ACEP Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache]
	Management of Adult Patients Presenting to the Emergency Department With Acute Headache]

	==Video==		==Video==

Elcatracho: /* External Links */

2021-01-13T17:14:23Z

External Links

← Revisión anterior		Revisión del 17:14 13 ene 2021
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	==External Links==		==External Links==
	*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]		*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]
	*[https://www.acep.org/patient-care/clinical-policies/headache/ACEP Clinical Policy: Critical Issues in the Evaluation and		*[https://www.acep.org/patient-care/clinical-policies/headache/ ACEP Clinical Policy: Critical Issues in the Evaluation and
	Management of Adult Patients Presenting to the Emergency Department With Acute Headache]		Management of Adult Patients Presenting to the Emergency Department With Acute Headache]

Elcatracho: /* External Links */

2021-01-13T17:13:39Z

External Links

← Revisión anterior		Revisión del 17:13 13 ene 2021
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	==External Links==		==External Links==
	*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]		*[http://ddxof.com/headache/ DDxOf: Differential Diagnosis of Headache]
			*[https://www.acep.org/patient-care/clinical-policies/headache/ACEP Clinical Policy: Critical Issues in the Evaluation and
			Management of Adult Patients Presenting to the Emergency Department With Acute Headache]

	==Video==		==Video==

Rossdonaldson1 at 23:13, 28 November 2019

2019-11-28T23:13:45Z

← Revisión anterior		Revisión del 23:13 28 nov 2019
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			{{Adult top}} [[headache (peds)]]
	==Background==		==Background==
	*Headache accounts for ~2.2% of all ED visits<ref>Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct;52(4):407-36. doi: 10.1016/j.annemergmed.2008.07.001.</ref>		*Headache accounts for ~2.2% of all ED visits<ref>Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW; American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct;52(4):407-36. doi: 10.1016/j.annemergmed.2008.07.001.</ref>

ClaireLewis: /* References */

2019-10-03T03:10:44Z

References

← Revisión anterior		Revisión del 03:10 3 oct 2019
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	[[Category:Neurology]]		[[Category:Neurology]]
			[[category:Symptoms]]