Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache
Publication Date: July 1, 2019
Patient Management Recommendations
Risk-stratification strategies
Use the Ottawa Subarachnoid Hemorrhage Rule ≥40 years, complaint of neck pain or stiffness, witnessed loss of consciousness, onset with exertion, thunderclap headache, and limited neck flexion on examination) as a decision rule that has high sensitivity to rule out SAH, but low specificity to rule in SAH, for patients presenting to the ED with a normal neurologic examination result and peak headache severity within 1 hour of onset of pain symptoms. (B)
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Pain management
Preferentially use nonopioid medications in the treatment of acute primary headaches in ED patients. (A)
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Imaging
Use a normal noncontrast head CT* performed within 6 hours of symptom onset in an ED headache patient with a normal neurologic examination, to rule out nontraumatic SAH. (B)
* Minimum third-generation scanner
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Perform LP or CTA to safely rule out SAH in the adult ED patient who is still considered to be at risk for SAH after a negative noncontrast head CT result. (C)
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Recommendation Grading
Disclaimer
Overview
Title
Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache
Authoring Organization
American College of Emergency Physicians
Publication Month/Year
July 1, 2019
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of adult patients presenting to the emergency department with acute headache.
Target Patient Population
Patients with acute headache
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Emergency care
Intended Users
Paramedic emt, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D004635 - Emergency Medicine, D006261 - Headache, D020773 - Headache Disorders
Keywords
headache, emergency medicine
Source Citation
Ann Emerg Med. 2019;74:e41-e74.
Methodology
Number of Source Documents
88
Literature Search Start Date
January 1, 2007
Literature Search End Date
July 3, 2017