Evidence-Based Emergency Department Management of Migraine and Other Primary Headaches (Pharmacology CME and Pain Management CME)

Points & Pearls Excerpt

• ED evaluation of headache can be summarized by the OPQRSTU mnemonic. Query the patient regarding: onset, provokes/palliates, quality, radiates, severity, timing, and under treatment.
• The physical examination focuses on excluding secondary causes of the headache. The neurologic examination is most important, and particular attention should be paid to the eyes.
• Results of the history and physical examination will dictate the need for further workup.
• Headaches may be episodic (<15 days/month) or chronic (≥15 days/month for 3 months).
• Chronic migraine affects nearly 2% of the population and is commonly seen in the ED.¹²