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Acute therapy of primary headaches includes intravenous rehydration, anti-emetics, corticosteroids, nonsteroidal anti-inflammatory drugs, dihydroergotamine, and serotonin 5-HT1B/1D receptor agonists. Different types of primary headaches may respond similarly to these therapies. Many headaches recur not long after treatment in the ED, and the natural history of the primary headaches is such that they will recur in the long term if not within hours to days of discharge. The ED physician must consider the possibility of post-ED headaches for patients presenting to the ED with primary headaches, and provide anticipatory management for these headaches. The appropriate management of primary headache relies on resources outside the ED, developed in collaboration with outpatient headache healthcare providers. This chapter will address post-ED headache management for primary headache patients.
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