The emergency management of headaches

Abstract

Background: Sufferers of severe headaches present for emergent treatment when attacks are unusually severe or refractory to therapy. Secondary headaches must always be considered.

Review summary: Most severe attacks are due to migraine, but cluster headaches may present for emergent treatment as well. It is unusual for a tension-type headache to be severe, unless it is associated with migraine. Options for emergent treatment of migraine depend upon which treatments have been recently utilized and what associated symptoms are present.

Conclusions: Options include neuroleptics, triptans, nonsteroidal antiinflammatory agents, ergots, and intravenous valproic acid. Cluster headaches are best managed with oxygen inhalation, injectable sumatriptan, or dihydroergotamine.