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The Emergency Management of Headaches

Green, Mark W. MD

doi: 10.1097/01.nrl.0000051443.03160.72

BACKGROUND— Sufferers of severe headaches present for emergent treatment when attacks are unusually severe or refractory to therapy. Secondary headaches must always be considered.

REVIEW SUMMARY— Most severe attacks are due to migraine, but cluster headaches may present for emergent treatment as well. It is unusual for a tension-type headache to be severe, unless it is associated with migraine. Options for emergent treatment of migraine depend upon which treatments have been recently utilized and what associated symptoms are present.

CONCLUSIONS— Options include neuroleptics, triptans, nonsteroidal antiinflammatory agents, ergots, and intravenous valproic acid. Cluster headaches are best managed with oxygen inhalation, injectable sumatriptan, or dihydroergotamine.

From the Columbia-Presbyterian Headache Center, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA

Send reprints requests to Mark W. Green, MD, Columbia Presbyterian Headache Center, 16 East 60th Street, Suite 310, New York, NY 10022. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.