Abstract
The acute headache in the emergency department (ED) poses a diagnostic dilemma that
may overwhelm providers attempting to weigh the cost of advanced workups against the
risk of missing serious pathology. While the majority of headache concerns are benign
primary headache disorders, identifying life-threatening secondary causes of headache—which
may be broadly categorized into structural, infectious, and vascular causes—is the
primary focus of evaluation in the ED. Secondary headaches are associated with a high
morbidity and mortality, and require strict scrutiny of the history and physical examination
to adequately risk-stratify patients. Innovative and emerging technologies may further
assist providers in the diagnosis of headache, and challenge previous gold-standard
diagnostic evaluations. Herein, we present a general overview of the workup and management
of headaches in the ED, with a special section for diagnostic considerations in evaluating
for acute meningitis, subarachnoid hemorrhage, and acute angle-closure glaucoma.
Keywords
acute headache - emergency department - secondary headache - malignant pathology
