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Headache

Last updated: January 12, 2023

Summarytoggle arrow icon

Headache is a symptom commonly encountered in everyday clinical practice, and, according to the WHO, one of the ten most common causes of functional disability. It may be primary (e.g., tension-type headaches, migraine) or secondary (e.g., following head trauma or infections) in nature. Although most episodes of headache are harmless, potentially life-threatening causes (e.g., subarachnoid hemorrhage, meningitis) should always be considered. Identifying the cause of headaches is often difficult and requires a detailed clinical history as well as a thorough physical examination. Additional diagnostics, e.g., imaging, are only indicated if headaches persist despite treatment or if specific clinical features are present that are signs of an underlying disease. This article gives an overview of the most common types of headache and serves as a guide to diagnosing different headache disorders.

Approachtoggle arrow icon

Approach to management

  1. Check vital signs.
  2. Perform focused history and examination.
  3. If red flags are present:
    • Obtain brain imaging (either CT or MRI brain with and/or without contrast) based on the red flag symptoms. [1]
    • Perform further targeted diagnostics (see below).
  4. If no red flags are present and suspicion for life-threatening causes is low:
    • Perform a detailed history and clinical exam.
    • Consider whether further diagnostic testing is necessary.
  5. Provide supportive care.
  6. Identify and treat the underlying cause.

Headache red flags (SNOOP10) [1][2]

The original mnemonic, SNOOP has more recently been expanded to cover the following total of 15 red flags:

  • Systemic symptoms (e.g., fever, signs of meningitis, myalgia, malaise)
  • Neoplasm in history
  • Neurological deficits/dysfunction (e.g., altered mental status, seizures) [3]
  • Onset of headache is sudden or abrupt
  • Older age at onset (> 50 years)
  • Pattern changes of headache or recent onset
  • Positional headache
  • Precipitated by sneezing, coughing, or exercise
  • Papilledema and other signs of increased ICP
  • Progressive headache and atypical features
  • Pregnancy or postpartum period
  • Pain of the eye with autonomic features and visual deficits
  • Posttraumatic onset
  • Pathology of the immune system (especially due to HIV)
  • Painkiller overuse or new drug at onset of headache

A new or progressive headache in a patient aged > 50 years may indicate tumor or hemorrhage and should always be treated as a high-risk headache.

Life-threatening conditions [1]

Definitiontoggle arrow icon

Epidemiologytoggle arrow icon

  • Lifetime prevalence: > 90%, with female predominance (except cluster headache) [5]
  • Most common forms of headache [5]
    • Tension-type headache: 40–80% of cases
    • Migraine: 10% of cases

Among patients presenting to the emergency department with headaches, primary headache (most frequently migraine) is the most common type, but up to 5% may have a secondary headache with a serious life-threatening cause. [6]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

See “Differential diagnoses” below.

Clinical featurestoggle arrow icon

History of present illness

Maintain a high index of suspicion for secondary headache in patients with a new, sudden-onset severe headache.

Past medical history, social history, and family history

Physical examination

Consider secondary life-threatening causes if red flags for headache are present!

Diagnosticstoggle arrow icon

Approach [7]

  • Check vital signs, obtain a history, and perform a physical and neurological examination.
  • Determine the need for further testing based on risk stratification and the suspected diagnosis.
    • Low-risk headache: No routine laboratory tests or imaging are recommended.
    • High-risk headache: Consider diagnostic workup based on the suspected diagnosis.

In patients who are unstable or have signs of increased ICP, diagnostics should not delay stabilization (e.g., ABCDE approach) and neuroprotective measures.

The diagnostic modality should be determined by the patient history and clinical presentation. Primary headache is a clinical diagnosis and typically does not require laboratory or imaging evaluation.

Risk stratification of headache [7][8]

Clinical features
Low-risk headache
High-risk headache

Response to analgesics should not be used for risk stratification! Pursue a diagnostic workup for high-risk features even if headache improves with initial treatment. [10][11]

In the emergency department, use the Ottawa subarachnoid hemorrhage (SAH) clinical decision rule to rule out SAH in patients presenting with rapid onset headache and a normal neurological examination. [12]

Laboratory studies

Imaging [12][13]

Recommended initial imaging modality for headache [14]
Initial test of choice Alternatives
Sudden-onset severe headache (i.e., thunderclap headache)
  • CT head without IV contrast
  • CTA with IV contrast
New headache with papilledema
  • MRI head
    • Without contrast
    • Without and with IV contrast
  • CT head without IV contrast
  • CTV head with IV contrast
  • MRV head
    • Without IV contrast
    • Without and with IV contrast
  • CT head with IV contrast
New or worsening headache related to head trauma or accompanied by red flags
  • CT head without IV contrast
  • MRI head
    • Without IV contrast
    • Without and with IV contrast
  • N/A

New primary headache suspected to be of trigeminal autonomic origin

(e.g., cluster headache)

  • MRI head without and with IV contrast
  • MRI head without IV contrast
Chronic headache with new features or change in character, severity, or frequency
  • MRI head
    • Without IV contrast
    • Without and with IV contrast
  • CT head
    • Without and with IV contrast
    • Without IV contrast

In patients presenting to the emergency department with acute headache and a normal neurological examination, a negative head CT without contrast indicates that the diagnosis of SAH is unlikely, even when performed < 6 hours from the onset of headache (see “Diagnostics” in “Subarachnoid hemorrhage.”) [12]

Avoid imaging in patients presenting with a recurrent known migraine unless new concerning features are present, e.g., seizures, focal neurological deficits, or recent change in headache pattern.

Additional diagnostics to consider [13]

In the emergency department, if SAH is still suspected despite a normal head CT without contrast, either LP or CTA can be used as a second-line test to safely rule out the diagnosis (see “Diagnostics” in “Subarachnoid hemorrhage”). [12]

In patients with suspected meningitis or encephalitis, do not delay lumbar puncture unless the patient meets the criteria for imaging prior to LP.

Primary headachestoggle arrow icon

Types of primary headaches [15]
Characteristics Tension-type headache Migraine headache Cluster headache

Mixed type headache [4]
Epidemiology
Triggers/exacerbating factors
Clinical features Attack duration
  • 30 minutes to 7 days
  • 4–72 hours
  • 15–180 minutes
  • Short, recurring attacks
  • Hours to days
Frequency
  • Occasionally to daily (usually at the end of the day)
  • Episodic or chronic
  • Occasionally to several times a month
  • Episodic or chronic
  • 1–3 episodes every 24 hours
  • Usually occur in a cyclical pattern (cluster periods) with remissions lasting ≥ 3 months (i.e., episodic CH), but may also occur with remissions lasting < 3 months or no remission (i.e., chronic CH)
  • Episodic or chronic
Localization
  • 60% of cases are unilateral.
  • Exclusively unilateral
  • Localized to the periorbital and/or temporal region
Character
  • Dull, nonpulsating, band-like or vise-like pain
  • Constant
  • Pulsating, boring/hammering pain
  • Often burning or piercing pain
  • Attacks develop within minutes
  • Often wakes patients up from sleep
Intensity
  • Mild to moderate
  • Moderate to severe
  • Severe, agonizing pain
  • Mild to severe
Additional symptoms
Diagnostics
Management

“POUND:“ pulsatile, one-day duration, unilateral, nausea, and disabling intensity are the typical features of migraine headache.

In the emergency department, nonopioid pain medications are preferred for the treatment of acute primary headaches. [12]

Secondary headachestoggle arrow icon

Diagnosis Clinical features Diagnostic findings Acute management
Meningitis [18][19][20]
Intracerebral hemorrhage [21][22]
Subarachnoid hemorrhage [23]
Subdural hematoma (SDH)
  • CT head without contrast: crescent-shaped, concave, hyperdense hemorrhage that crosses suture lines but not the midline
Epidural hematoma [24]
  • CT head without contrast: biconvex, hyperdense lesion
Cerebral venous sinus thrombosis [25]
Giant cell arteritis [27][28][29][30]
Hypertensive crises [31][32]
Ischemic stroke [33][34]
Intracranial space-occupying lesions (e.g., brain tumors) [35][36][37]
Concussion (e.g., mild traumatic brain injury) [38][39][40]
Acute angle-closure glaucoma

[41][42]
Trigeminal neuralgia [44][45]
  • Paroxysmal (seconds to 2 minutes) and stabbing pain
  • Unilateral facial pain, strictly localized to the distribution of the branches of the trigeminal nerve
  • Frequency and intensity of episodes usually increase over time
  • Tender trigger points
  • Triggered by chewing, talking, cold, and touching specific areas of the face
  • No neurological deficits
Medication overuse headache
  • Headache with variable characteristics
  • History of analgesic overuse
  • Autonomic symptoms (e.g., nausea)
  • Cognitive or behavioral symptoms (e.g., comorbid depression)

Consider eye examination in patients with unexplained acute-onset severe headache with nausea and vomiting to evaluate for signs of acute angle-closure glaucoma.

Differential diagnosestoggle arrow icon

Primary headache

Secondary headache

The differential diagnoses listed here are not exhaustive.

Dispositiontoggle arrow icon

Most patients with primary headaches and benign secondary headaches can be managed as outpatients. [6]

Indications for hospitalization

Discharge from the emergency department

Discharge home is appropriate once life-threatening causes of headache have been ruled out and the patient's symptoms improve with initial treatment (even if the headache is not completely resolved). [6]

  • Consider appropriate prescription of analgesics and preventive medication based on the underlying diagnosis.
  • Provide patient counseling and education.
  • Ensure outpatient primary care follow-up, especially for patients at high risk of early recurrence. [10]
  • Consider referral to neurology or a specialized headache clinic.

Appropriate discharge planning is important to ensure ongoing care and reduce unnecessary return visits to the emergency department e.g., due to recurrent headaches or incomplete treatment.

Referencestoggle arrow icon

  1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38 (1): p.1-211.doi: 10.1177/0333102417738202 . | Open in Read by QxMD
  2. Rizzoli P, Mullally WJ. Headache. Am J Med. 2018; 131 (1): p.17-24.doi: 10.1016/j.amjmed.2017.09.005 . | Open in Read by QxMD
  3. Luciani M, Negro A, Spuntarelli V, Bentivegna E, Martelletti P. Evaluating and managing severe headache in the emergency department. Expert Rev Neurother. 2021; 21 (3): p.277-285.doi: 10.1080/14737175.2021.1863148 . | Open in Read by QxMD
  4. Ravishankar K. “WHICH Headache to Investigate, WHEN, and HOW?”. Headache: The Journal of Head and Face Pain. 2016; 56 (10): p.1685-1697.doi: 10.1111/head.12998 . | Open in Read by QxMD
  5. Uggetti C, et al.. Headache in the emergency department: the role of imaging. Neurological Sciences. 2018; 39 (S1): p.151-152.doi: 10.1007/s10072-018-3379-1 . | Open in Read by QxMD
  6. Pascual J, González-Mandly A, Martín R, Oterino A. Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain.. 2008; 9 (5): p.259-266.doi: 10.1007/s10194-008-0063-5 . | Open in Read by QxMD
  7. Swadron SP. Pitfalls in the Management of Headache in the Emergency Department. Emerg Med Clin North Am. 2010; 28 (1): p.127-147.doi: 10.1016/j.emc.2009.09.007 . | Open in Read by QxMD
  8. Pope JV, Edlow JA. Favorable Response to Analgesics Does Not Predict a Benign Etiology of Headache. Headache.. 2008; 48 (6): p.944-950.doi: 10.1111/j.1526-4610.2008.01127.x . | Open in Read by QxMD
  9. Godwin SA, Cherkas DS, Panagos PD, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Ann Emerg Med. 2019; 74 (4): p.e41-e74.doi: 10.1016/j.annemergmed.2019.07.009 . | Open in Read by QxMD
  10. Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Ann Emerg Med. 2008; 52 (4): p.407-436.doi: 10.1016/j.annemergmed.2008.07.001 . | Open in Read by QxMD
  11. Whitehead MT, Cardenas AM, Corey AS, et al. American College of Radiology ACR Appropriateness Criteria® Headache. J Am Coll Radiol. 2019.doi: 10.1016/j.jacr.2019.05.030 . | Open in Read by QxMD
  12. Hainer BL, Matheson EM. Approach to acute headache in adults.. Am Fam Physician. 2013; 87 (10): p.682-7.
  13. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.. Neurology. 2019; 92 (3): p.134-144.doi: 10.1212/WNL.0000000000006697 . | Open in Read by QxMD
  14. Schankin CJ, Kästele F, Gerdes LA, et al. New-Onset Headache in Patients With Autoimmune Encephalitis Is Associated With anti-NMDA-Receptor Antibodies. Headache: The Journal of Head and Face Pain. 2016; 56 (6): p.995-1003.doi: 10.1111/head.12853 . | Open in Read by QxMD
  15. The International Classification of Headache Disorders 3rd Edition. https://www.ichd-3.org/. Updated: January 1, 2016. Accessed: April 2, 2017.
  16. Silberstein SD. Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000; 55 (6): p.754-762.doi: 10.1212/wnl.55.6.754 . | Open in Read by QxMD
  17. Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Therapeutic Advances in Neurological Disorders. 2013; 6 (6): p.369-374.doi: 10.1177/1756285613489765 . | Open in Read by QxMD
  18. Bamberger DM. Diagnosis, initial management, and prevention of meningitis.. Am Fam Physician. 2010; 82 (12): p.1491-8.
  19. Seehusen DA, Reeves MM, Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003; 68 (6): p.1103-1108.
  20. Mount HR, Boyle SD. Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention.. Am Fam Physician. 2017; 96 (5): p.314-322.
  21. Hemphill JC, Greenberg SM, Anderson CS et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke. 2015; 46 (7).doi: 10.1161/STR.0000000000000069 . | Open in Read by QxMD
  22. Claude Hemphill J, Lam A. Emergency Neurological Life Support: Intracerebral Hemorrhage. Neurocrit Care. 2017; 27 (S1): p.89-101.doi: 10.1007/s12028-017-0453-0 . | Open in Read by QxMD
  23. Connolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012; 43 (6): p.1711-1737.doi: 10.1161/STR.0b013e3182587839 . | Open in Read by QxMD
  24. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas.. Neurosurgery. 2006; 58 (3 Suppl): p.S7-15; discussion Si-iv.
  25. Saposnik G, Barinagarrementeria F, Brown RD, et al. Diagnosis and Management of Cerebral Venous Thrombosis. Stroke. 2011; 42 (4): p.1158-1192.doi: 10.1161/str.0b013e31820a8364 . | Open in Read by QxMD
  26. Wasay M, Azeemuddin M. Neuroimaging of Cerebral Venous Thrombosis. Journal of Neuroimaging. 2005; 15 (2): p.118-128.doi: 10.1111/j.1552-6569.2005.tb00296.x . | Open in Read by QxMD
  27. Weyand CM, Goronzy JJ. Giant-Cell Arteritis and Polymyalgia Rheumatica. N Engl J Med. 2014; 371 (1): p.50-57.doi: 10.1056/nejmcp1214825 . | Open in Read by QxMD
  28. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia Rheumatica and Giant-Cell Arteritis. N Engl J Med. 2002; 347 (4): p.261-271.doi: 10.1056/nejmra011913 . | Open in Read by QxMD
  29. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008; 372 (9634): p.234-245.doi: 10.1016/s0140-6736(08)61077-6 . | Open in Read by QxMD
  30. Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology. 2010; 49 (8): p.1594-1597.doi: 10.1093/rheumatology/keq039a . | Open in Read by QxMD
  31. Peixoto AJ. Acute Severe Hypertension. N Engl J Med. 2019; 381 (19): p.1843-1852.doi: 10.1056/nejmcp1901117 . | Open in Read by QxMD
  32. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018; 138 (17).doi: 10.1161/cir.0000000000000597 . | Open in Read by QxMD
  33. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; 49 (3).doi: 10.1161/str.0000000000000158 . | Open in Read by QxMD
  34. Rudkin S, Cerejo R, Tayal A, Goldberg MF. Imaging of acute ischemic stroke. Emerg Radiol. 2018; 25 (6): p.659-672.doi: 10.1007/s10140-018-1623-x . | Open in Read by QxMD
  35. Overview of Intracranial Tumors. https://www.merckmanuals.com/professional/neurologic-disorders/intracranial-and-spinal-tumors/overview-of-intracranial-tumors. Updated: June 1, 2019. Accessed: November 25, 2019.
  36. Brain Tumors. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Brain-Tumors. . Accessed: November 24, 2019.
  37. Villanueva-Meyer JE, et al.. Current Clinical Brain Tumor Imaging. Neurosurgery. 2017; 81 (3): p.397-415.doi: 10.1093/neuros/nyx103 . | Open in Read by QxMD
  38. Reams N, Bodnya J. Concussion management. Disease-a-Month. 2019; 65 (10): p.100853.doi: 10.1016/j.disamonth.2019.02.006 . | Open in Read by QxMD
  39. Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013; 80 (24): p.2250-2257.doi: 10.1212/wnl.0b013e31828d57dd . | Open in Read by QxMD
  40. McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013; 47 (5): p.250-258.doi: 10.1136/bjsports-2013-092313 . | Open in Read by QxMD
  41. Angle-Closure Glaucoma. https://www.aao.org/munnerlyn-laser-surgery-center/angleclosure-glaucoma-19. Updated: December 18, 2013. Accessed: March 17, 2017.
  42. Acute Closed Angle Glaucoma. https://www.ncbi.nlm.nih.gov/books/NBK430857/. Updated: January 1, 2019. Accessed: November 25, 2019.
  43. Baum J, Chaturvedi N, Netland PA, Dreyer EB. Assessment of Intraocular Pressure by Palpation. Am J Ophthalmol. 1995; 119 (5): p.650-651.doi: 10.1016/s0002-9394(14)70227-2 . | Open in Read by QxMD
  44. Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia. Neurology. 2016; 87 (2): p.220-228.doi: 10.1212/wnl.0000000000002840 . | Open in Read by QxMD
  45. Trigeminal neuralgia. https://ichd-3.org/13-painful-cranial-neuropathies-and-other-facial-pains/13-1-trigeminal-neuralgia/13-1-1-classical-trigeminal-neuralgia/. . Accessed: November 3, 2019.
  46. Nelson JA. Local skull trephination before transfer is associated with favorable outcomes in cerebral herniation from epidural hematoma. Acad Emerg Med. 2011; 18 (1): p.78-85.doi: 10.1111/j.1553-2712.2010.00949.x . | Open in Read by QxMD
  47. Fischer C. Master the Boards USMLE Step 2 CK. Kaplan Publishing ; 2015
  48. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013; 13 (4): p.533-540.
  49. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice Guidelines for the Management of Bacterial Meningitis. Clinical Infectious Diseases. 2004; 39 (9): p.1267-1284.doi: 10.1086/425368 . | Open in Read by QxMD
  50. Orr SL, Friedman BW, Christie S, et al. Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache: The Journal of Head and Face Pain. 2016; 56 (6): p.911-940.doi: 10.1111/head.12835 . | Open in Read by QxMD
  51. $Medication-overuse headache (MOH).
  52. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice guideline update summary: Acute treatment of migraine in children and adolescents. Neurology. 2019; 93 (11): p.487-499.doi: 10.1212/wnl.0000000000008095 . | Open in Read by QxMD
  53. Colman I, Friedman BW, Brown MD, et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ. 2008; 336 (7657): p.1359-1361.doi: 10.1136/bmj.39566.806725.be . | Open in Read by QxMD
  54. Shahien R, Saleh SA, Bowirrat A. Intravenous sodium valproate aborts migraine headaches rapidly. Acta Neurol Scand. 2011; 123 (4): p.257-265.doi: 10.1111/j.1600-0404.2010.01394.x . | Open in Read by QxMD
  55. $Tension-type headache (TTH).
  56. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral Headache Treatment: History, Review of the Empirical Literature, and Methodological Critique. Headache: The Journal of Head and Face Pain. 2005; 45 (s2): p.S92-S109.doi: 10.1111/j.1526-4610.2005.4502003.x . | Open in Read by QxMD
  57. Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ. Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache. 2016; 56 (7): p.1093-1106.doi: 10.1111/head.12866 . | Open in Read by QxMD
  58. Beck E, Sieber WJ, Trejo R. Management of cluster headache.. Am Fam Physician. 2005; 71 (4): p.717-24.
  59. Francis GJ, Becker WJ, Pringsheim TM. Acute and preventive pharmacologic treatment of cluster headache. Neurology. 2010; 75 (5): p.463-473.doi: 10.1212/wnl.0b013e3181eb58c8 . | Open in Read by QxMD
  60. Rossi P, Lorenzo CD, Faroni J, Cesarino F, Nappi G. Advice Alone Vs. Structured Detoxification Programmes for Medication Overuse Headache: A Prospective, Randomized, Open-Label Trial in Transformed Migraine Patients With Low Medical Needs. Cephalalgia. 2006; 26 (9): p.1097-1105.doi: 10.1111/j.1468-2982.2006.01175.x . | Open in Read by QxMD
  61. Evers S, Jensen R. Treatment of medication overuse headache - guideline of the EFNS headache panel. Eur J Neurol. 2011; 18 (9): p.1115-1121.doi: 10.1111/j.1468-1331.2011.03497.x . | Open in Read by QxMD
  62. Altieri M, Di Giambattista R, Di Clemente L, et al. Combined Pharmacological and Short-Term Psychodynamic Psychotherapy for Probable Medication Overuse Headache: A Pilot Study. Cephalalgia. 2009; 29 (3): p.293-299.doi: 10.1111/j.1468-2982.2008.01717.x . | Open in Read by QxMD
  63. Krymchantowski A, Barbosa J. Prednisone as Initial Treatment of Analgesic-Induced Daily Headache. Cephalalgia. 2000; 20 (2): p.107-113.doi: 10.1046/j.1468-2982.2000.00028.x . | Open in Read by QxMD
  64. Goh BT, Poon CY, Peck RHL. The importance of routine magnetic resonance imaging in trigeminal neuralgia diagnosis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2001; 92 (4): p.424-429.doi: 10.1067/moe.2001.115130 . | Open in Read by QxMD
  65. Gronseth G, Cruccu G, Alksne J, et al. Practice Parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008; 71 (15): p.1183-1190.doi: 10.1212/01.wnl.0000326598.83183.04 . | Open in Read by QxMD
  66. Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology. 2019; 26 (6): p.831-849.doi: 10.1111/ene.13950 . | Open in Read by QxMD
  67. Frontera JA, Lewin III JJ, Rabinstein AA, et al. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage. Neurocrit Care. 2015; 24 (1): p.6-46.doi: 10.1007/s12028-015-0222-x . | Open in Read by QxMD
  68. Makris M, Van Veen JJ, Tait CR, Mumford AD, Laffan M. Guideline on the management of bleeding in patients on antithrombotic agents. Br J Haematol. 2012; 160 (1): p.35-46.doi: 10.1111/bjh.12107 . | Open in Read by QxMD
  69. Rizos T, Jenetzky E, Herweh C, Unterberg A, Hacke W, Veltkamp R. Fast point-of-care coagulometer guided reversal of oral anticoagulation at the bedside hastens management of acute subdural hemorrhage.. Neurocrit Care. 2010; 13 (3): p.321-5.doi: 10.1007/s12028-010-9443-1 . | Open in Read by QxMD
  70. Thomas S, Makris M. The reversal of anticoagulation in clinical practice .. Clin Med. 2018; 18 (4): p.314-319.doi: 10.7861/clinmedicine.18-4-314 . | Open in Read by QxMD
  71. Haselsberger K, Pucher R, Auer LM. Prognosis after acute subdural or epidural haemorrhage.. Acta Neurochir (Wien). 1988; 90 (3-4): p.111-6.doi: 10.1007/bf01560563 . | Open in Read by QxMD
  72. Oertel M, Kelly DF, McArthur D, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury.. J Neurosurg. 2002; 96 (1): p.109-16.doi: 10.3171/jns.2002.96.1.0109 . | Open in Read by QxMD
  73. Han SR. Conservative management of a rapidly calcifying epidural hematoma in a young male patient. Interdisciplinary Neurosurgery. 2015; 2 (4): p.183-185.doi: 10.1016/j.inat.2015.08.003 . | Open in Read by QxMD
  74. Won S-Y, Dubinski D, Bruder M, Cattani A, Seifert V, Konczalla J. Acute subdural hematoma in patients on oral anticoagulant therapy: management and outcome. Neurosurg Focus. 2017; 43 (5): p.E12.doi: 10.3171/2017.8.focus17421 . | Open in Read by QxMD
  75. Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours.. N Engl J Med. 1981; 304 (25): p.1511-8.doi: 10.1056/NEJM198106183042503 . | Open in Read by QxMD
  76. Li H, Pan R, Wang H, et al. Clipping Versus Coiling for Ruptured Intracranial Aneurysms. Stroke. 2013; 44 (1): p.29-37.doi: 10.1161/strokeaha.112.663559 . | Open in Read by QxMD
  77. Bederson JB, Connolly ES, Batjer HH, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage. Stroke. 2009; 40 (3): p.994-1025.doi: 10.1161/strokeaha.108.191395 . | Open in Read by QxMD
  78. Gigante P, Hwang BY, Appelboom G, Kellner CP, Kellner MA, Connolly ES. External ventricular drainage following aneurysmal subarachnoid haemorrhage. Br J Neurosurg. 2010; 24 (6): p.625-632.doi: 10.3109/02688697.2010.505989 . | Open in Read by QxMD
  79. Diringer MN, Bleck TP, Claude Hemphill J, et al. Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care. 2011; 15 (2): p.211-240.doi: 10.1007/s12028-011-9605-9 . | Open in Read by QxMD
  80. Muralidharan R. External ventricular drains: Management and complications. Surgical Neurology International. 2015; 6 (7): p.271.doi: 10.4103/2152-7806.157620 . | Open in Read by QxMD
  81. Bisnaire D, Robinson L. Accuracy of levelling intraventricular collection drainage systems.. J Neurosci Nurs. 1997; 29 (4): p.261-8.doi: 10.1097/01376517-199708000-00008 . | Open in Read by QxMD
  82. CHRISTENSEN TD, LARSEN TB. Precision and accuracy of point-of-care testing coagulometers used for self-testing and self-management of oral anticoagulation therapy. Journal of Thrombosis and Haemostasis. 2012; 10 (2): p.251-260.doi: 10.1111/j.1538-7836.2011.04568.x . | Open in Read by QxMD
  83. Velat GJ, Kimball MM, Mocco JD, Hoh BL. Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Review of Randomized Controlled Trials and Meta-Analyses in the Literature. World Neurosurgery. 2011; 76 (5): p.446-454.doi: 10.1016/j.wneu.2011.02.030 . | Open in Read by QxMD
  84. Tichter AM, Malhi J. Does Magnesium Therapy in Aneurysmal Subarachnoid Hemorrhage Affect Clinical Outcome?. Ann Emerg Med. 2017; 69 (2): p.208-209.doi: 10.1016/j.annemergmed.2016.05.027 . | Open in Read by QxMD
  85. Zazulia A, Diringer M. Aneurysmal Subarachnoid Hemorrhage: Strategies for Preventing Vasospasm in the Intensive Care Unit. Semin Respir Crit Care Med. 2017; 38 (06): p.760-767.doi: 10.1055/s-0037-1607990 . | Open in Read by QxMD
  86. Kirkpatrick PJ, Turner CL, Smith C, Hutchinson PJ, Murray GD. Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial. The Lancet Neurology. 2014; 13 (7): p.666-675.doi: 10.1016/s1474-4422(14)70084-5 . | Open in Read by QxMD
  87. Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016; 375 (11): p.1033-1043.doi: 10.1056/nejmoa1603460 . | Open in Read by QxMD
  88. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) investigators.. Antihypertensive treatment of acute cerebral hemorrhage.. Crit Care Med. 2010; 38 (2): p.637-48.doi: 10.1097/CCM.0b013e3181b9e1a5 . | Open in Read by QxMD
  89. Anderson CS, Heeley E, Huang Y, et al. Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage. N Engl J Med. 2013; 368 (25): p.2355-2365.doi: 10.1056/nejmoa1214609 . | Open in Read by QxMD
  90. Sports-Related Concussion. https://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/sports-related-concussion. Updated: November 1, 2017. Accessed: November 15, 2019.
  91. Concussion. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Concussion. . Accessed: November 15, 2019.
  92. Angle-Closure Glaucoma. https://www.merckmanuals.com/professional/eye-disorders/glaucoma/angle-closure-glaucoma. Updated: October 1, 2019. Accessed: November 25, 2019.
  93. Ropper AH. Management of raised intracranial pressure and hyperosmolar therapy. Pract Neurol. 2014; 14 (3): p.152-158.doi: 10.1136/practneurol-2014-000811 . | Open in Read by QxMD
  94. Helbok R, Kurtz P, Schmidt JM, et al. Effect of mannitol on brain metabolism and tissue oxygenation in severe haemorrhagic stroke. Journal of Neurology, Neurosurgery & Psychiatry. 2010; 82 (4): p.378-383.doi: 10.1136/jnnp.2009.198754 . | Open in Read by QxMD
  95. Gerard C, Busl KM. Treatment of Acute Subdural Hematoma. Curr Treat Options Neurol. 2013; 16 (1).doi: 10.1007/s11940-013-0275-0 . | Open in Read by QxMD
  96. Mosarla RC, et al.. Anticoagulation Strategies in Patients With Cancer. J Am Coll Cardiol. 2019; 73 (11): p.1336-1349.doi: 10.1016/j.jacc.2019.01.017 . | Open in Read by QxMD
  97. American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. Headache: The Journal of Head and Face Pain. 2018; 59 (1): p.1-18.doi: 10.1111/head.13456 . | Open in Read by QxMD
  98. Marmura MJ, Silberstein SD, Schwedt TJ. The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies. Headache: The Journal of Head and Face Pain. 2015; 55 (1): p.3-20.doi: 10.1111/head.12499 . | Open in Read by QxMD
  99. D’Souza RS, Mercogliano C, Ojukwu E, et al. Effects of prophylactic anticholinergic medications to decrease extrapyramidal side effects in patients taking acute antiemetic drugs: a systematic review and meta-analysis. Emergency Medicine Journal. 2018; 35 (5): p.325-331.doi: 10.1136/emermed-2017-206944 . | Open in Read by QxMD
  100. Al‐Saffar A, Lennernäs H, Hellström PM. Gastroparesis, metoclopramide, and tardive dyskinesia: Risk revisited. Neurogastroenterology & Motility. 2019: p.e13617.doi: 10.1111/nmo.13617 . | Open in Read by QxMD
  101. Wijemanne S, Jankovic J, Evans RW. Movement Disorders From the Use of Metoclopramide and Other Antiemetics in the Treatment of Migraine. Headache: The Journal of Head and Face Pain. 2015; 56 (1): p.153-161.doi: 10.1111/head.12712 . | Open in Read by QxMD
  102. Wei DY, Khalil M, Goadsby PJ. Managing cluster headache. Pract Neurol. 2019; 19 (6): p.521-528.doi: 10.1136/practneurol-2018-002124 . | Open in Read by QxMD
  103. May A. Cluster headache: pathogenesis, diagnosis, and management. Lancet. 2005; 366 (9488): p.843-855.doi: 10.1016/s0140-6736(05)67217-0 . | Open in Read by QxMD
  104. Burish MJ. Cluster Headache: History, Mechanisms, and Most Importantly, Treatment Options. Practical Neurology. 2017: p.34-36.
  105. Moore D, Chong MS, Shetty A, Zakrzewska JM. A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br J Anaesth. 2019; 123 (2): p.e385-e396.doi: 10.1016/j.bja.2019.05.026 . | Open in Read by QxMD
  106. Broderick J, et al.. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults. Stroke. 2007; 38 (6): p.2001-2023.doi: 10.1161/strokeaha.107.183689 . | Open in Read by QxMD
  107. Ravishankar K. The art of history-taking in a headache patient. Annals of Indian Academy of Neurology. 2012; 15 (5): p.7.doi: 10.4103/0972-2327.99989 . | Open in Read by QxMD
  108. Prum BE, Herndon LW, Moroi SE, et al. Primary Angle Closure Preferred Practice Pattern® Guidelines. Ophthalmology. 2016; 123 (1): p.P1-P40.doi: 10.1016/j.ophtha.2015.10.049 . | Open in Read by QxMD
  109. Flores-Sánchez BC, Tatham AJ. Acute angle closure glaucoma. Br J Hosp Med. 2019; 80 (12): p.C174-C179.doi: 10.12968/hmed.2019.80.12.c174 . | Open in Read by QxMD
  110. Ferro JM, Canhão P. Acute treatment of cerebral venous and dural sinus thrombosis. Curr Treat Options Neurol. 2008; 10 (2): p.126-137.doi: 10.1007/s11940-008-0014-0 . | Open in Read by QxMD
  111. Einhäupl KM, Villringer A, Mehraein S, et al. Heparin treatment in sinus venous thrombosis. The Lancet. 1991; 338 (8767): p.597-600.doi: 10.1016/0140-6736(91)90607-q . | Open in Read by QxMD
  112. Fomchenko EI, Gilmore EJ, Matouk CC, Gerrard JL, Sheth KN. Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas. Curr Treat Options Neurol. 2018; 20 (8).doi: 10.1007/s11940-018-0517-2 . | Open in Read by QxMD
  113. Ortega-Gutierrez S, et al. Effectiveness and Safety of Nicardipine and Labetalol Infusion for Blood Pressure Management in Patients with Intracerebral and Subarachnoid Hemorrhage. Neurocrit Care. 2012; 18 (1): p.13-19.doi: 10.1007/s12028-012-9782-1 . | Open in Read by QxMD

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