WASHINGTON, D.C.—A headache is one of the common presentations in the emergency department. Of course, the vast majority of them are no big deal. Still, they could be deadly, so be vigilant. Just not so vigilant you order unnecessary imaging. But, obviously, don’t skip a scan that could miss a diagnostic clue of dangerous secondary causes. Also, patients need immediate and effective pain relief. Not opioids, though.
Headache management is enough to give emergency physicians, well, a headache.
Physicians are “told don’t miss anything dangerous, but rarely are you going to see something dangerous,” said Matthew Siket, MD, FACEP, presenter of “Stop the Pounding: Update on Headache Assessment and Treatment” Tuesday at ACEP17. “But also don’t over-image. Don’t get CT scans when you don’t have to. That puts us in a difficult spot in the middle. So what we’re left with when we’re stripped of all that, really, is our history and our physical exam. And these aren’t the patients that want you to spend a lot of time talking to them or examining them.”