Evaluation of the Patient With Nontraumatic Headache: An Evidence Based Approach

Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage

“…P atients with headache account for 1%-2% of visits to the emergency department (ED). [1][2][3] Most have primary headache disorders (such as migraine and tension-type headaches) that are not life threatening; however, within this group of patients, a subgroup of approximately 1%-4% has a nontraumatic subarachnoid hemorrhage (SAH), which can represent a catastrophic event. [1][2][3] The annual incidence of nontraumatic SAH is believed to range from approximately 11 to 25 per 100,000 population in the United States and results in at least 25,000 cases annually.…”

“…[1][2][3] Most have primary headache disorders (such as migraine and tension-type headaches) that are not life threatening; however, within this group of patients, a subgroup of approximately 1%-4% has a nontraumatic subarachnoid hemorrhage (SAH), which can represent a catastrophic event. [1][2][3] The annual incidence of nontraumatic SAH is believed to range from approximately 11 to 25 per 100,000 population in the United States and results in at least 25,000 cases annually. [1][2][3][4] Early detection is critical because as many as 25% of patients may die within 24 hours, and the three-month mortality rate has been estimated to be as high as 50% without early definitive treatment.…”

Use of Atraumatic Spinal Needles Among Neurologists in the United States

“…Since its introduction over 100 years ago, 1 lumbar puncture has become a routine procedure for neurologists, oncologists, emergency department physicians, pediatricians, radiologists, family practitioners, and anesthesiologists. [2][3][4][5][6] One of the most common and bothersome complications of lumbar puncture is postdural puncture headache (PDPH), which is characterized by distressing symptoms that include head-ache, back pain, dizziness, nausea, and vomiting. 7,8 Postdural puncture headache may follow spinal anesthesia, as first described by Bier in 1899, but also occurs following diagnostic lumbar puncture.…”

Management of Pediatric Migraine Headache in the Emergency Room and Infusion Center

“…In these cases, further work up such us imaging is recommended. 1,2 Migraine headache represents one-third of the referrals to the ED: 18-21%. 3,4 Children and adolescents usually wait an average of 2 days trying outpatient therapies before coming in for more aggressive therapy to an ED or infusion center.…”