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Headache, Cephalgia

  • Epidemiology
  1. Incidence
    1. ER Visits in U.S annually: 3 Million (15% of all ER Visits)
    2. Secondary Headaches (e.g. Subarachnoid Hemorrhage, Meningitis) represent 2% of cases
  2. Costs
    1. Cost due to lost work per year US: $5-17 Billion
  • Precautions
  1. See Headache Red Flag
  2. Relieving acute Headache pain does not obviate the need to distinguish primary from Secondary Headache
  3. Discerning Secondary Headache is critical in the Headache Evaluation
    1. Although <2% of acute Headaches, missing Secondary Headache can have devastating consequences
  • Differential Diagnosis
  1. See Headache Causes
  2. Primary Headache (98% of Headaches in the Emergency Department)
    1. Migraine Headache (80% are without aura)
    2. Cluster Headache
    3. Tension Headache
  3. Secondary Headache (important selected causes)
    1. See Headache Red Flag
    2. Localized Headache
      1. Temporal Arteritis (temporal pain in over age 50 years)
      2. Acute Angle-Closure Glaucoma (severe Eye Pain)
    3. Fever
      1. Bacterial Meningitis
    4. Exposure related
      1. Carbon Monoxide Poisoning (typically furnace in winter)
      2. Post-Traumatic Headache
    5. Young Women
      1. Pregnancy Induced Hypertension
      2. Pseudotumor Cerebri (Obesity)
    6. Thunderclap Headaches (severe sudden-onset)
      1. Subarachnoid Hemorrhage
      2. Cervical artery dissection (carotid dissection, vertebrobasilar dissection)
      3. Venous sinus thrombosis
      4. Pituitary apoplexy
    7. Anatomic neurologic deficits
      1. Intracranial Mass
      2. Cerebellar Infarction
  • Management
  1. See Headache General Measures
  2. Management directed at specific Headache type
  • Resources
  1. National Headache Foundation
    1. http://www.headaches.org
  • References
  1. Cutrer in Goldman (2000) Cecil Medicine, p. 2066
  2. Henry in Marx (2002) Rosen's Emergency Medicine, p. 152
  3. Pruitt in Goroll (2000) Primary Care Medicine, p. 931-9
  4. Clinch (2001) Am Fam Physician 63(4):685-92 [PubMed]
  5. Coutin (1996) Am Fam Physician 54(7):2247-52 [PubMed]
  6. Saper (1999) Med Clin North Am 83(3):663-90 [PubMed]