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Emergency Department and Inpatient Management of Headache in Adults

  • Headache (R. H. Singh, Section Editor)
  • Published:
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Abstract

Purpose of Review

This article reviews treatment options for patients presenting with headache in the emergency department (ED) and for inpatients, including red flags and status migrainosus (SM).

Recent Findings

Most patients presenting with headache in the ED will have migraine, but red flags must be reviewed to rule out secondary headaches. SM refractory to home treatment is a common reason for ED presentation or inpatient admission, but high-quality treatment evidence is lacking. Common treatments include intravenous fluids, anti-dopaminergic agents with diphenhydramine, steroids, divalproex, nonsteroidal anti-inflammatory drugs, intravenous dihydroergotamine, and nerve blocks. Other therapies (e.g., ketamine and lidocaine) are used with limited or inconsistent evidence. There is evidence for inpatient behavioral management therapy.

Summary

This article details red flags to review in the workup of headache presentation in the ED and provides a step-wise approach to ED and inpatient management. However, more studies are needed to better optimize care.

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Abbreviations

AHS:

American Headache Society

DHE:

Dihydroergotamine

ED:

Emergency department

EFNS:

European Federation for Neurological Sciences

IV:

Intravenous

IVF:

Intravenous fluid

NSAID:

Nonsteroidal anti-inflammatory drug

RCT:

Randomized controlled trial

SM:

Status migrainosus

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Acknowledgments

The authors thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation.

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Authors and Affiliations

  1. Jan and Tom Lewis Migraine Treatment Program, Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Jennifer Robblee

  2. Cerebrovascular and Hospital Neurology, Penrose Neuroscience, Colorado Springs, CO, USA

    Kate W. Grimsrud

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Robblee: literature review, writing, figure creation, and table creation. Grimsrud: writing and table creation.

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Correspondence to Jennifer Robblee.

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Robblee, J., Grimsrud, K.W. Emergency Department and Inpatient Management of Headache in Adults. Curr Neurol Neurosci Rep 20, 7 (2020). https://doi.org/10.1007/s11910-020-01030-w

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