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Sudden Headache in the Emergency Department
  1. Richard Davenport, Consultant Neurologist
  1. Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK; E-mail: rjd{at}



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

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