Headache Specialists Dissatisfied With Emergency Department Headache Care

A distraught man with his head in his hands in a waiting room
A distraught man with his head in his hands in a waiting room
Investigators used a survey to better understand whether headache specialists adhere to headache management protocols and the strategies used to prevent ED visits for headache.

The majority of headache specialists are dissatisfied with the care patients receive during a headache-related emergency department visit, according to survey results published in Headache.

Members of the American Headache Society who belonged to the Emergency Department/Refractory/Inpatient Section were surveyed on their thoughts about the prevention of headache-related emergency department visits, the creation and implementation of headache protocols in the emergency department, and communication between the clinician and the emergency department.

The survey was completed by 52% of the target clinicians (N=50), and 80% were from an academic institution while 20% were from private practices. In regards to management of patients, 77.5% provide acute treatment options for over 91% of their patients, 46% provide rescue treatments for at least half of their patients, and only 20% provide instructions for emergency department treatments. For severe, ongoing headache management, 22% provide office availability for patients, while 40% direct patients to an emergency department. A protocol for handling an ongoing, severe headache is present at 54% of the specialist’s offices, and these are used 62.6% of the time. Headache specialists provide a written emergency department plan for the patient 24% of the time and call ahead to the emergency department 52% of the time. The majority of headache specialists surveyed reported being not satisfied, often not satisfied, or inconsistently satisfied 62% of the time in regards to the management of headaches in the emergency department.

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In conclusion, most headache specialists are not satisfied with the emergency departments handling of their patients with ongoing, severe headaches. Communication, including standard protocols and follow-up details, could improve headache management care in the emergency departments.


Minen MT, Ortega E, Lipton RB, Cowan R. American Headache Society survey about urgent and emergency management of headache patients [published online September 12, 2018]. Headache. doi: 10.1111/head.13387