Evaluation and Management of Life-Threatening Headaches in the Emergency Department

Though patients often present to the ED seeking relief from headaches that cause significant pain and suffering, 90% of them can be considered “benign.” It is essential to identify the 10% of headache patients who are in danger of having a life-threatening disorder presenting with a sudden and severe headache to ensure that they are treated quickly and effectively.

What are the red flags for recognizing that a headache is potentially life-threatening?

What are the most common causes of life-threatening headaches? (Subarachnoid hemorrhage, cervical artery dissection, central venous thrombosis, idiopathic intracranial hypertension, giant cell arteritis, and posterior reversible encephalopathy syndrome.)

What are the signs and symptoms of these headaches?

When your patient describes his headache, what are the six descriptors that are most concerning?

What are the high-yield laboratory tests?

When SAH is suspected, when is CT required? When is it not?

When is neuroimaging required prior to performing a lumbar puncture?

When is IV antihypertensive medication called for? Which drugs and what dosage?

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