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

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Points and Pearls Excerpt

  • The most common life-threatening causes of headaches are subarachnoid hemorrhage (SAH), cervical artery dissection (CAD), cerebral venous thrombosis (CVT), idiopathic intracranial hypertension (IIH), giant cell arteritis (GCA), and posterior reversible encephalopathy syndrome (PRES), and pre-eclampsia.
  • SAH is commonly caused by aneurysm rupture; 75% present with abrupt onset. Administer nimodipine in aneurysmal SAH to improve outcomes. The use of prophylactic antiepileptic drugs is controversial.
  • CAD is commonly associated with trauma and connective tissue disorders. Treat extracranial dissections with IV heparin followed by warfarin or a direct oral anticoagulant. Treat intracranial dissections with aspirin or clopidogrel.
  • CVT presents as a gradual-onset headache that is often the result of thrombotic disease and spreading facial infections. Treat with low-molecular weight heparin or heparin bridge to warfarin. Consider broad-spectrum antibiotics if an infectious etiology is suspected.

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Publication Information
Authors

David Zodda, MD, FACEP; Gabrielle Procopio, PharmD, BCPS; Amit Gupta, MD

Peer Reviewed By

Mert Erogul, MD; Steven A. Godwin, MD, FACEP

Publication Date

February 1, 2019

Pub Med ID: 30676714

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