Headache emergencies

Headache is a common complaint in the emergency department. Although the most common causes of headaches are benign, the differential diagnosis is vast and can include potentially catastrophic neurologic etiologies. It is important to identify those with high risk of having a secondary headache in order to expedite further workup and management thereby reducing the risk of morbidity and mortality. The most important information regarding a headache comes from the patient’s history and physical examination. History alone can help you discern if it is most likely a primary benign headache or concerning secondary headache syndrome. Most emergencies presenting with headaches can be ruled out with a CT of the head and/or a lumbar puncture with CSF investigations. However, a thorough history and examination will aid in forming a differential diagnosis and help fine-tune ongoing investigations and treatment.