Caution Ahead

Abstract

Headache is a commonly encountered symptom in urgent care and the emergency department. Headache syndromes are classified a primary headache and do not require neuroimaging; however, patients should be assessed at each encounter for changes in their headache symptoms. This case highlights a patient who was suffering from a new headache type, characterized as different from her previous attacks and unyielding to her current acute and preventive treatment methods. The patient was sent for neuroimaging and found to have a mass within her sella turcica that required surgical intervention and removal. Assessing headache patients for red flag symptoms can uncover significant alterations in the patient's symptomatology and indicate a need for further evaluation. By evaluating for red flag symptoms, clinicians can ensure the delivery of high-quality care and better health care outcomes for patients with headache disease.

Primary Headache Approach in the Emergency Departments: A Systematic Scoping Review of Prospective Studies

“…In this scoping review, it was found that the main triggers of primary headaches include a history of migraine and similar episodes [5,19]. In this regard, some studies have described that at least half of the patients with primary headaches, examined in the emergency services, indicate that these patients have previously experienced similar pain [27][28][29].…”

“…It has also been reported that, although the intensity of pain due to primary headache is slightly higher in patients treated in emergency departments, compared to those evaluated in ambulatory medical services, it is possible that more than the pain itself, the perception of pain, and the presence of stressful events, and/or psychiatric comorbidities (anxiety or depression), may explain the decision to seek medical care in the emergency department during a headache attack [ 27 ].…”

“…It has been described that tension-type headache is the most common type of primary headache [ 26 ], while others have indicated that it is a migraine followed by unspecified headache [ 27 ]. These diagnostic differences may be due to overcrowding in emergency services, the short time to obtain a detailed clinical history of the headache, and the difficulty in obtaining an accurate history of the patient's headache during the painful phase.…”