Headaches (ED revision)
Scope and purpose
Headache is a frequent ED presentation.
In people aged 12 years and older (NICE CG150) the core task is to separate common primary headaches (tension‑type, migraine, cluster) from secondary causes that may be life‑threatening (subarachnoid haemorrhage, meningitis, intracranial mass, temporal arteritis, acute narrow‑angle glaucoma, cerebral venous sinus thrombosis, etc.).
This section summarises the ED approach, key diagnostic features, immediate management, investigation/referral triggers and practical safety‑netting aligned with NICE (CG150) and related UK guidance (NG12, NG127).
Key objectives
- Recognise red flags requiring urgent investigation or specialist input.
- Perform a focused history and examination to distinguish primary from secondary headache.
- Provide evidence‑based acute treatments appropriate for the ED.
- Identify and manage medication‑overuse headache.
- Know the urgent pathway for thunderclap headache/suspected subarachnoid haemorrhage (SAH).
- Understand when neuroimaging is indicated and when imaging for reassurance is inappropriate.
NICE CG150 red flags (urgent assessment / imaging / specialist review)
(Adapted from NICE - Headaches in over 12s: diagnosis and management - CG150)
- New or worsening headache with fever.
- Sudden‑onset headache reaching maximal intensity within minutes (thunderclap).