The emergency evaluation of headache is organized around distinguishing primary headache disorders (migraine, cluster, tension), which represent the majority of presentations and require only symptomatic treatment, from secondary headache disorders caused by organic pathology such as subarachnoid hemorrhage or meningitis, which require urgent identification. This distinction is made through a structured history (onset characteristics, associated neurologic symptoms, activity at onset, prior headache pattern) and physical examination (fundoscopy for papilledema, neurologic exam, assessment for meningismus), which together determine whether further diagnostic workup—such as non-contrast head CT, CT angiography/venography, laboratory testing, or lumbar puncture—is warranted.
The emergency evaluation of headache is organized around distinguishing primary headache disorders (migraine, cluster, tension), which represent the majority of presentations and require only symptom…