Benign Headaches in the ED - Dr. Goldonowicz

- Only approximately 5% of all headaches that present in the ED are true emergencies
- After evaluating for potential emergencies and performing a full neuro exam, pause and consider if any of the following Red Flags are present:

• First or worst
• Neuro abnormalities
• Associated symptoms
• Persistent location/time of day
• Unresponsive to treatment
• Cancer, HIV, Trauma
• Change in pattern, frequency, severity

To diagnose migraine, need 5 separate episodes of headache characterized by:

• 4 - 72 hours in length
• Unilateral
• Pulsating
• Moderate or severe
• Aggravated by routine activity
• With nausea/vomiting and/or photophobia/phonophobia

"Migraine” or undifferentiated benign headache, you can treat the same way in the ED

Best evidence for acute headache treatment includes the following:

• Dark and quiet room
• 1L Crystalloid
• 10mg IV or PO Reglan (or Compazine)
• 25mg IV or PO Benadryl +/-
• 30mg IV Toradol OR 550mg PO Naproxen OR 600mg PO Ibuprofen
• Consider 10mg IV Decadron to prevent short term headache recurrence

Avoid narcotics and barbiturates out of concern for dependency and rebound effect

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