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Emergency Department and Inpatient Management of Headache in Adults.
Curr Neurol Neurosci Rep. 2020 Mar 18; 20(4):7.CN

Abstract

PURPOSE OF REVIEW

This article reviews treatment options for patients presenting with headache in the emergency department (ED) and for inpatients, including red flags and status migrainosus (SM).

RECENT FINDINGS

Most patients presenting with headache in the ED will have migraine, but red flags must be reviewed to rule out secondary headaches. SM refractory to home treatment is a common reason for ED presentation or inpatient admission, but high-quality treatment evidence is lacking. Common treatments include intravenous fluids, anti-dopaminergic agents with diphenhydramine, steroids, divalproex, nonsteroidal anti-inflammatory drugs, intravenous dihydroergotamine, and nerve blocks. Other therapies (e.g., ketamine and lidocaine) are used with limited or inconsistent evidence. There is evidence for inpatient behavioral management therapy. This article details red flags to review in the workup of headache presentation in the ED and provides a step-wise approach to ED and inpatient management. However, more studies are needed to better optimize care.

Authors+Show Affiliations

Jan and Tom Lewis Migraine Treatment Program, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Neuropub@barrowneuro.org.Cerebrovascular and Hospital Neurology, Penrose Neuroscience, Colorado Springs, CO, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32189074

Citation

Robblee, Jennifer, and Kate W. Grimsrud. "Emergency Department and Inpatient Management of Headache in Adults." Current Neurology and Neuroscience Reports, vol. 20, no. 4, 2020, p. 7.
Robblee J, Grimsrud KW. Emergency Department and Inpatient Management of Headache in Adults. Curr Neurol Neurosci Rep. 2020;20(4):7.
Robblee, J., & Grimsrud, K. W. (2020). Emergency Department and Inpatient Management of Headache in Adults. Current Neurology and Neuroscience Reports, 20(4), 7. https://doi.org/10.1007/s11910-020-01030-w
Robblee J, Grimsrud KW. Emergency Department and Inpatient Management of Headache in Adults. Curr Neurol Neurosci Rep. 2020 Mar 18;20(4):7. PubMed PMID: 32189074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency Department and Inpatient Management of Headache in Adults. AU - Robblee,Jennifer, AU - Grimsrud,Kate W, Y1 - 2020/03/18/ PY - 2020/3/20/entrez PY - 2020/3/20/pubmed PY - 2020/3/20/medline KW - Emergency KW - Headache KW - Inpatient KW - Migraine KW - Red flags KW - Status migrainosus SP - 7 EP - 7 JF - Current neurology and neuroscience reports JO - Curr Neurol Neurosci Rep VL - 20 IS - 4 N2 - PURPOSE OF REVIEW: This article reviews treatment options for patients presenting with headache in the emergency department (ED) and for inpatients, including red flags and status migrainosus (SM). RECENT FINDINGS: Most patients presenting with headache in the ED will have migraine, but red flags must be reviewed to rule out secondary headaches. SM refractory to home treatment is a common reason for ED presentation or inpatient admission, but high-quality treatment evidence is lacking. Common treatments include intravenous fluids, anti-dopaminergic agents with diphenhydramine, steroids, divalproex, nonsteroidal anti-inflammatory drugs, intravenous dihydroergotamine, and nerve blocks. Other therapies (e.g., ketamine and lidocaine) are used with limited or inconsistent evidence. There is evidence for inpatient behavioral management therapy. This article details red flags to review in the workup of headache presentation in the ED and provides a step-wise approach to ED and inpatient management. However, more studies are needed to better optimize care. SN - 1534-6293 UR - https://www.unboundmedicine.com/medline/citation/32189074/Emergency_Department_and_Inpatient_Management_of_Headache_in_Adults L2 - https://dx.doi.org/10.1007/s11910-020-01030-w DB - PRIME DP - Unbound Medicine ER -
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