Clinical Commander

SYMPTOM-LED (ED) · symptom.headache.ed_undifferentiated· DEMO READY

Acute headache. Rule out the secondary/dangerous causes before treating empirically for primary headache.

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Authored pathway active · symptom.headache.ed_undifferentiated.ed

Acute headache. Rule out the secondary/dangerous causes before treating empirically for primary headache.

7 must-ask4 must-not-miss

Guidelines: ACEP 2019 Clinical Policy on Acute Headache · AAN 2019 Primary Care Management of Headache · Ottawa SAH Rule (Perry, JAMA 2013)

Phenotypes (4)

  • Headache ED - Thunderclap (Worst of Life)
  • Headache ED - Secondary (Red Flags Present)
  • Headache ED - Primary (Migraine/Cluster)
  • Headache ED - Hypertensive Emergency

Red flags (6)

  • Subarachnoid hemorrhage (thunderclap headache, max intensity within minutes, "worst of life", LOC, neck stiffness).CRITICAL
  • Bacterial meningitis (fever + headache + meningismus or AMS or new seizure).CRITICAL
  • Giant cell arteritis (age ≥ 50, new headache, jaw claudication, vision change, scalp tenderness, ESR/CRP elevated).CRITICAL
  • Elevated ICP / mass effect (papilledema, postural worsening, morning headache, AM nausea, focal deficit, new seizure).CRITICAL
  • +2 more

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symptom.headache.ed_undifferentiated · Emergency
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