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:

• Make a (correct) diagnosis.

• Investigate appropriately and at the appropriate time.

• Manage appropriately.

This does not mean expose every one to a brain scan