The emergency management of headaches.
BACKGROUND
Sufferers of severe headaches present for emergent treatment when attacks are unusually severe or refractory to therapy. Secondary headaches must always be considered.


RESULTS
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.
Green
Mark W
MW
Columbia-Presbyterian Headache Center, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10022, USA. mwg43@Columbia.edu
D003027:Cluster Headache / Q000188:drug therapy / Q000628:therapy; D004632:Emergency Medical Services; D006261:Headache / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy / Q000628:therapy; D010102:Oxygen Inhalation Therapy; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D018781:Tension-Type Headache / Q000188:drug therapy / Q000628:therapy
D017366:Serotonin Receptor Agonists