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Review 2: Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

Reviewer

Denise Marte, MD

Department of Emergency Medicine, Weill Cornell School of Medicine, New York, NY

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1. Article Citation
2. Synopsis
3. ABEM Quick Quiz
4. Discussion
   1. In the adult ED patient presenting with acute headache, are there risk-stratification strategies that reliably identify the need for emergent neuroimaging?
      1. Risk Stratification With Decision Tools
      2. Risk Stratification Based on Clinical Variables
      3. Risk Stratification Based on Biomarkers
   2. In the adult ED patient treated for acute primary headache, are nonopioids preferred to opioid medications?
   3. In the adult ED patient presenting with acute headache, does a normal noncontrast head CT scan performed within 6 hours of headache onset preclude the need for further diagnostic workup for SAH?
   4. In the adult ED patient who is still considered to be at risk for SAH after a negative noncon-trast head CT, is CTA of the head as effective as LP to safely rule out SAH?
      1. CTA for the Diagnosis of Cerebral Aneurysm
      2. Ability of CT/LP to Rule Out SAH in ED Headache Patients
      3. Low Diagnostic Yield of LP and CTA
      4. Diagnosis of SAH With Cerebrospinal Fluid Red Blood Cells on LP
      5. Additional Concerns With LP Testing
      6. Additional Concerns With CTA Testing
5. Critique
6. References
7. Editor's Note
8. ABEM Quick Quiz Answers
9. Key Points
10. Original Article

Article Citation

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Headache. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2019;74(4):e41-e74.

Synopsis

This clinical policy published by the American College of Emergency Physicians (ACEP) in 2019 addresses 4 clinical questions regarding the management of patients presenting to the emergency department (ED) with acute headache. The policy covers topics such as the need for imaging and additional testing as well as risk stratification and best medications for management.

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