Headache in the emergency department. How to handle the problem?

Patients presenting to the emergency department (ED) with a chief complaint of headache are common and are frequently clinically challenging. The primary role of ED physicians is to discriminate between the most common primary benign headaches and secondary potentially life-threatening headaches. There are several tools at the physician’s disposal to corroborate the diagnosis (anamnesis, examination, neuroimaging, lumbar puncture), but in the busy setting of the ED they are often inadequately used with respect to published standards and recommendations. In 2004 a multidisciplinary workgroup of the Emilia-Romagna region proposed a consensus-based diagnostic algorithm structured in four clinical scenarios aimed at reducing the variability exhibited by ED physicians in management of non-traumatic headache, improving clinical decision-making and optimising the use of limited resources.