June 15, 2017

Background: Presentations to the Emergency Department for acute headache are remarkably common, with more than 2 million visits each year in the United States (Goldstein 2006). Emergency clinicians are tasked with dual roles of excluding life-threatening pathology while rendering effective pain relief and symptomatic care. Treatment patterns for isolated benign headache are widely variable, reflecting the array of symptoms and diversity of therapeutic response among patients presenting for care. One observational cohort of ED patients reported the routine use of 36 different medications for the treatment of headache, with most patients receiving more than one parenteral agent, as well as frequent use of opioid therapy despite recommendations to avoid the same except as a last resort (Vinson 2002). While a variety of effective medications are available for treatment of primary headache in the Emergency Department, including NSAIDs, neuroleptics, anti-emetics, anti-epileptics, and more, there is a growing interest in alternative headache therapies that offer rapid relief without the side effects and time investment of more traditional agents.

March 31, 2014

Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 - 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms.  Additionally, post LP headaches that are left untreated can cause impaired ability to perform activities of daily living and there are case reports of subdural hematoma, herniation, and death. In terms of the prevention and treatment of post-LP headaches, both are equally important in management. Following, is a discussion of which techniques and preventative measures are evidence based and which are not.