RED FLAG IN HEADACHE

Headache represents up to 4 percent of all emergency department visits(US). Emergency physicians generally are concerned with identifying those patients whose headache are caused by life-threatening conditions. Most patients, however, have benign primary headache syndromes and are concerned with receiving rapid and effective treatment for their headache

Indication for ordering head CT scan non-trauma (Emergency medicine : Shirley Ooi 2004)

• acute onset of the "first or worst" headache
• increased frequency and increased severity of headache
• new onset headache after 50 years old
• new onset headache with history of CA or immunocompromised
• headache with mental state changes
• headache with fever,neck stiffness and meningeal signs

Approach to Patients with headache in the Emergency Department

The 1996 American College of Emergency Physicians' (ACEP's) Clinical Policy for Adults with Headache groups all causes of headache into four broad categories (Table ). Evaluation of the headachepatient has four essential objectives:

ACEP HeadacheCategories

Headache Category Examples I. Critical secondary causes requiring emergent identification and treatment Subarachnoid hemorrhage, meningitis, brain tumor with raised ICP II. Critical secondary causes not necessarily requiring emergent identification or treatment Brain tumor without raised ICP III. Generally benign and reversible secondary causes Sinusitis, hypertension, post–lumbar puncture headache IV. Primary headache syndromes Migraine, tension type, or cluster

Abbreviations: ACEP = American College of Emergency Physicians; ICP = intracranial pressure