Evidence-Based Diagnosis of Nontraumatic Headache in the Emergency Department: A Consensus Statement on Four Clinical Scenarios Posted 06/22/2004 Pietro Cortelli, MD; Sabina Cevoli, MD; Francesco Nonino, MD; Dante Baronciani, MD; Nicola Magrini, MD; Giuseppe Re, MD; Gianni De Berti, MD; Gian Camillo Manzoni, MD; Pietro Querzani, MD; Alberto Vandelli, MD Abstract and Introduction Abstract Objective: To provide to emergency department (ED) physicians with guidelines for diagnosis of patients with nontraumatic headaches. Background: Many patients present to an ED with the chief complaint of headache. Causes of nontraumatic headache include life-threatening illnesses, and distinguishing patients with such ominous headaches from those with a primary headache disorder can be challenging for the ED physician. Conclusion: We present a consensus statement aimed to be a useful tool for ED doctors in making evidence-based diagnostic decisions in the management of adult patients with nontraumatic headache. Methods: A multidisciplinary work performed an extensive review of the medical literature and applied the information obtained to commonly encountered scenarios in the ED. Introduction Headache is one of the most common symptoms and a major reason for medical consultation. Of all patients accessing emergency departments (EDs) 1.7% to 4.5% report nontraumatic headache (NTH) as their primary medical problem. [1-3] The first step in evaluating such patients involves exclusion of secondary headaches that reflect an underlying life-threatening conditions (eg, subarachnoid hemorrhage). [4] Given the wide variability of presenting signs and symptoms, differential diagnosis between primary and secondary NTH can be challenging for ED doctors, and uncertainty in some cases may lead to unnecessary hospital admission. [1-4] The teaching hospital in Modena (a town with 176,000 inhabitants in the Emilia Romagna region, northern Italy), receives 21,000 ED patient visits each year. Of 9724 patients evaluated in the period from January to June 2001, 335 patients (3.5%) complained of NTH as their primary medical problem. Of those patients 123 (37%) were admitted, and 52 (50%) were subsequently discharged with a diagnosis of migraine, tension-type headache, or unspecified headache. Those patients with a final diagnosis of primary headache typically manageable in an outpatient setting are defined as "inappropriate admissions" by the Admission Criteria of the Regional Health Authority, which promotes initiatives to improve the quality of health care. These findings led to the constitution of a multiprofessional work group to produce a consensus statement on the diagnosis and treatment of NTH in the ED.