Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

Publication Date: July 1, 2019
Last Updated: March 14, 2022

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

Publication Month/Year

July 1, 2019

Last Updated Month/Year

June 13, 2023

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