Management of the Headache Patient in the ED

This year, JC kicks off our 2016-2017 academic year one month late and we would like to extend a warm JC welcome to our new interns and EM/PA & PEDS-EM fellows. We thought it would be great to stick with July’s distribution and better yet, this month, our Peds-EM colleagues will be joining us.  Headache remains a challenging ED complaint. Our risk tolerance for missing “bad things” is pretty low and our approach to management is all over the place. This can send mixed messages to a patient population that often returns to the same ED. Included for your review are a few recent publications on patient management.  In addition we will ask our community faculty to assist with their “real world” approaches to patient assessment and treatment. Our pediatric colleagues perspective will also be incredibly helpful. Also included, is a hilarious quiz from CJEM that I encourage you to take, consider your practitioner category or maybe even offer up a new one.  

 Huber A. The CJEM Quiz: What kind of emergency physician are you? CJEM. 1999 Apr;1(1):64-5.

Gaffigan ME et al A Randomized Controlled Trial of Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department. J Emerg Med. 2015 Sep;49(3):326-34.  Appraisal

Friedman BW et al Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016 Jan;67(1):32-39.  Appraisal

Law S, et al Sumatriptan plus naproxen for the treatment of acute migraine attacks in adults. Cochrane Database Syst Rev. 2016 Apr 20   Appraisal

Patniyot IR, Gelfand AA,  Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache. 2016 Jan (1):49-70.  Appraisal

Richer et al, Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev. 2016 Apr 19 Appraisal