Ceppi Mirco, Willi Carole, Hugli Olivier, Regli Luca, Cereda Carlo, Maeder Philippe, Bodenmann Patrick, Burnand Bernard, Nater Bernard, Michel Patrik
Centre interdisciplinaire des urgences, CHUV, Lausanne.
Rev Med Suisse. 2008 Aug 20;4(167):1741-6.
Acute non-traumatic headache is a frequent complaint in emergency primary care. In the majority of cases, the cause is a primary headache, which can be invalidating, but should not lead to additional investigations. Secondary headaches are rare but their diagnosis is essential to avoid potentially lethal consequences. In practice, a primary headache may be difficult to differentiate from a secondary headache, especially if the initial management does not follow a systematic approach. We have adapted evidence-based guidelines to improve the diagnostic management of patients presenting acute headache. We propose an algorithm that facilitates the systematic screening of alert signs with a focused patient history and clinical exam. In the presence of red flags, appropriate complementary exams are needed to rule out a secondary headache.