Headaches are a common disorder, are the fourth commonest reason for attending an emergency department (ED) and account for around 1% of 999 calls. They are often poorly managed. Paramedics will encounter patients with headache disorders regardless of where they work. These presentations, however, can challenge clinicians because of the complexities of assessment and the potential repercussions of missing a significant pathology. The vast majority of headaches that present to the ED are primary migraines. Nonetheless, paramedics need to be aware of the potential for sinister causes; around 0.5% of sinister headache pathologies are missed at first presentation. This article gives an overview of headache categorisation and diagnosis, discusses the characteristics of migraines given their prevalence, and outlines how to assess and manage patients in emergency and urgent care settings.

Naomi Lafitte -