ACEP E-QUAL 32: Headache Clinical Policy

In this episode from the ACEP-EQUAL series, Dr. Steven Godwin and Dr. Richard Shih review the recently published ACEP clinical policy regarding the treatment of headaches in the emergency department.

Guests: Dr. Steven Godwin (Professor and Chair of Emergency Medicine, University of Florida), Dr. Richard Shih  (Professor of Integrated Medical Science and Program, Charles E Schmidt College of Medicine at Florida Atlantic University)

Host: Dr. Jason Woods; Podcast Sound Engineer: Kellen Vu

www.acep.org/equal

References:

1. Perry JJ et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013 Sep 25;310(12):1248-55. doi: 10.1001/jama.2013.278018 Carpenter CR et al. Spontaneous Subarachnoid Hemorrhage. A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds. Acad Emerg Med. 2016 Sep;23(9):963-1003. doi: 10.1111/acem.12984. Epub 2016 Sep 6.
2. Perry JJ. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4277 Dubosh NM et al. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386.
3. Carstairs SD. Computed tomographic angiography for the evaluation of aneruysmal subarachnoid hemorrhage. Acad Emerg Med. 2006 May;13(5):486-92. Epub 2006 Mar 21.
4. El Khaldi M. et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. La radiologia medica. 200 Feb;112(1):123–137.
5. Menke J et al. Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol. 2011 Apr;69(4):646-54. doi: 10.1002/ana.22270.
6. Friedman BW et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Nov 14; 89(20): 2075–2082. doi: 10.1212/WNL.0000000000004642