Context and Definition


The presentation of a patient with a severe headache to the emergency department (ED) is a common one. Whilst most are benign in nature, a small percentage represent potentially devastating aetiologies.

The task of the ED doctor is to differentiate between the two.

The doctor must be guided by the knowledge that:

  • Extensive investigation of all cases will result in many false positives
  • Failure to identify headaches due to serious aetiologies can result in fatal, or irreversible, outcomes


The International Headache Society classifies headaches into primary and secondary groupings. Primary headaches are those where the specific aetiology is not fully understood e.g. migraine. Secondary headaches have a clear and understandable origin e.g. ruptured aneurysm.

Primary causes are sometimes referred to as benign. However, this term is misleading as they are associated with considerable morbidity and indirect mortality.

This session will cover primary headaches.

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