Acute headache management in emergency department. A narrative review
Autor: | Raffaele Costantini, Giannapia Affaitati, Paolo Martelletti, Maria Adele Giamberardino, Martina Guglielmetti |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
emergency department Referral Triptans secondary headache 030204 cardiovascular system & hematology drugs Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Internal Medicine medicine Humans migraine Meningitis 030212 general & internal medicine Intensive care medicine medicine.diagnostic_test Brain Neoplasms business.industry Lumbar puncture Cluster headache Anti-Inflammatory Agents Non-Steroidal Headache Disease Management Glaucoma headache management Emergency department Subarachnoid Hemorrhage medicine.disease Analgesics Opioid Migraine Emergency Medicine Headaches medicine.symptom Emergency Service Hospital business medicine.drug |
Zdroj: | Internal and Emergency Medicine. 15:109-117 |
ISSN: | 1970-9366 1828-0447 |
Popis: | Headache is a significant reason for access to Emergency Departments (ED) worldwide. Though primary forms represent the vast majority, the life-threatening potential of secondary forms, such as subarachnoid hemorrage or meningitis, makes it imperative for the ED physician to rule out secondary headaches as first step, based on clinical history, careful physical (especially neurological) examination and, if appropriate, hematochemical analyses, neuroimaging or lumbar puncture. Once secondary forms are excluded, distinction among primary forms should be performed, based on the international headache classification criteria. Most frequent primary forms motivating ED observation are acute migraine attacks, particularly status migrainous, and cluster headache. Though universally accepted guidelines do not exist for headache management in an emergency setting, pharmacological parenteral treatment remains the principal approach worldwide, with NSAIDs, neuroleptic antinauseants, triptans and corticosteroids, tailored to the specific headache type. Opioids should be avoided, for their scarce effectiveness in the acute phase, while IV hydration should be limited in cases of ascertained dehydration. Referral of the patient to a Headache Center should subsequently be an integral part of the ED approach to the headache patients, being ascertained that lack of this referral involves a high rate of relapse and new accesses to the ED. More controlled studies are needed to establish specific protocols of management for the headache patient in the ED. |
Databáze: | OpenAIRE |
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