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Headache is one of the most common chief complaints in the emergency department (ED). Several demographic and other factors are associated with the propensity to visit the ED with headache. Whereas primary headaches are the most common cause of headache in the adult ED, secondary, non-life-threatening causes, such as headaches associated with viral illnesses, underlie most headaches in the pediatric ED. Costs associated with ED headache visits are high, partly due to the rising use of neuroimaging in this patient population. Several strategies could help to mitigate the cost of headache care in the ED, primarily by aiming to improve community-based care for patients with primary headaches. In this chapter, a detailed overview of the epidemiology of headache in the ED is provided.
Medication overuse headache (MOH) is defined as headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more, or 15 or more days per month, depending on the medication) for more than three months. Triptans, NSAIDs, acetaminophen, ergotamine, barbiturates, and opioids can all cause MOH. Although the optimal treatment strategy for MOH is debated, treatments include discontinuing the overused medications and treating with preventive migraine medications. In the ED, it is important to recognize patients who have MOH to provide appropriate treatment recommendations for MOH and to avoid perpetuating the patient’s medication overuse. In general, ED treatment of the patient with frequent headaches should not include narcotics or butalbital-containing medications as they are associated with the highest risk of developing MOH as well as the potential to create drug-seeking behavior. Proper follow-up should be arranged prior to discharge from the ED.
Do you need current and pragmatic guidance in meeting the challenges of acute headache assessment under pressure? Authored by renowned experts in neurology and emergency medicine, this versatile handbook offers practitioners a broad perspective on common, less-common, and rare headache disorders to enable accurate patient diagnosis and effective treatment. Featuring a multidisciplinary team of authors, this textbook provides clinicians who work in acute care settings with the right tools to recognise and understand primary headache disorders and life threatening causes of headache. Covering the best available evidence and practice standards from the emergency department, this guide provides direct answers to challenging management problems. Invaluable and extensively researched, practitioners are able to confidently evaluate a spectrum of conditions, while balancing resource utilization and cost considerations in a time-constrained environment.