Pitfalls

The pitfalls when assessing and treating headache in the ED are:

• Failure to consider brain tumours in apparently healthy young-to-middle-aged patients with no focal neurology, but reported cognitive/personality changes

• Failure to consider vertebral artery dissection in patients under 45 who present with stroke or unilateral headache

• Failure to consider cerebral venous thrombosis in young patients who present with headache and seizure

• Failure to routinely measure the opening pressure in all patients with headache undergoing LP, and thus missing the diagnosis of benign intra-cranial hypertension

• Unfounded belief that pain relieved by analgesics, or a normal CT scan, excludes a SAH

• Failure to consider pre-eclampsia in pregnant and post partum women

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