TY - JOUR T1 - ACUTE HEADACHE IN THE EMERGENCY DEPARTMENT JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - ii33 LP - ii37 DO - 10.1136/jnnp.72.suppl_2.ii33 VL - 72 IS - suppl 2 AU - Richard Davenport Y1 - 2002/06/01 UR - http://jnnp.bmj.com/content/72/suppl_2/ii33.abstract N2 - A bout one fifth of the patients seen by a general neurologist in the UK will present with headache; the majority have a chronic or stable syndrome (mostly migraine and chronic daily headache). Most patients are assessed in the relative peace and calm of the outpatient clinic, and their management is dealt with elsewhere in this supplement. A small proportion of headache patients will present acutely, either directly to the emergency department (ED), or referred via their general practitioner (GP). They account for between 1–2% of admissions to an ED.1 This article focuses on the diagnosis and early management of acute or recent onset headache, which I have arbitrarily defined as the onset of a new headache syndrome within the last few days, hours or even minutes. I recognise that in many areas of the UK patients presenting as an emergency with a headache are rarely seen by a neurologist (of any grade) within the acute phase, if indeed at all; nevertheless, this article is written primarily as a guide for the neurological trainee when faced with a “headache in the ED”. The primary objectives for the neurologist are deceptively simple—make the diagnosis, relieve the headache, and investigate and manage appropriately. As many as a third of patients presenting to the ED with acute headache will be harbouring potentially fatal or disabling intracranial conditions such as subarachnoid haemorrhage (SAH), but all will be in distress, alarmed and often frightened. These emotions may be reflected in their medical attendants, and there is a tendency to channel the patient immediately towards the nearest scanner, in the hope that this will identify the cause. Certainly it will delay the need for active thought; it may also delay the patient receiving appropriate treatment. The neurologist must maintain his or her calm, and remember … ER -