Key Chapter Points
Migraine is the #1 diagnosis of non-traumatic headache seen in the emergency department, accounting for 40–60% of all non-traumatic, emergency headaches.
Emergency care of headache focuses on treatment of dehydration, nausea, and pain.
Patients should rate their pain and nausea each using a visual analog scale from 0 (no symptoms) to 10 (severe symptoms). Target treatments that reduce both ratings to near zero to reduce the chance of headache recurrence.
Non-drug treatments (e.g., ice packs, noise restriction, and light dimming) can substantially enhance symptomatic relief in the emergency room.
The anti-emetic of choice for pregnant and lactating women is ondansetron.
The pain medication treatments of choice for pregnant women include intravenous therapy with ketorolac (second trimester only), magnesium, or hydromorphone.
The pain medication treatments of choice for lactating women include subcutaneous sumatriptan or intravenous therapy with ketorolac, valproate (provided that reliable contraception can be ensured), magnesium, or hydromorphone.
Patients with residual headache after standard treatments may benefit from a greater occipital nerve block and/or a short course of prednisone.
Since most emergency headaches are caused by recurring, primary headaches, follow-up care for future headache management is required.
Written instructions enhance communication of post-discharge care and follow-up instructions.