Acute Headache in the Emergency Department

About one fifth of the patients seen by a general neurologist in the UK will present with headache; the majority have a chronic or stable syndrome (mostly migraine and chronic daily headache). Most patients are assessed in the relative peace and calm of the outpatient clinic, and their management is dealt with elsewhere in this supplement. A small proportion of headache patients will present acutely, either directly to the emergency department (ED), or referred via their general practitioner (GP). They account for between 1–2% of admissions to an ED. This article focuses on the diagnosis and early management of acute or recent onset headache, which I have arbitrarily defined as the onset of a new headache syndrome within the last few days, hours or even minutes. I recognise that in many areas of the UK patients presenting as an emergency with a headache are rarely seen by a neurologist (of any grade) within the acute phase, if indeed at all; nevertheless, this article is written primarily as a guide for the neurological trainee when faced with a “headache in the ED”.