Sudden Headache in the Emergency Department
- Richard Davenport, Consultant Neurologist
- Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK; E-mail: rjd{at}skull.dcn.ed.ac.uk
Abstract
INTRODUCTION
Headache is a common symptom that most of us have experienced at some time in our lives. Fortunately for doctors, only a minority of people with headache seek a medical opinion, but even so, headache is a common presenting symptom in primary care, and perhaps the most common single symptom general neurologists expect to see in their clinics. Most of these patients present in a non-urgent setting, and are dealt with as outpatients. However, some present as an emergency; indeed, headache accounts for 1–2% of patients presenting to an emergency department (Barton 1994; Morgenstern et al. 2001; Ward et al. 2001).
When asked to see a patient in the emergency department with a headache, the goals for the physician are straightforward:
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Make a (correct) diagnosis.
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Investigate appropriately and at the appropriate time.
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Manage appropriately.
This does not mean expose every one to a brain scan
