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Evidence-Based Diagnosis of Nontraumatic Headache in the Emergency Department: A Consensus Statement on Four Clinical Scenarios


  • Pietro Cortelli MD,

  • Sabina Cevoli MD,

  • Francesco Nonino MD,

  • Dante Baronciani MD,

  • Nicola Magrini MD,

  • Giuseppe Re MD,

  • Gianni De Berti MD,

  • Gian Camillo Manzoni MD,

  • Pietro Querzani MD,

  • Alberto Vandelli MD,

  • Multidisciplinary Group for Nontraumatic Headache in the Emergency Department

  • From the Department of Neurological Sciences, University of Modena-Reggio Emilia, Modena (Dr. Cortelli); Department of Neurological Sciences, University of Bologna, Bologna (Dr. Cevoli); Ce.V.E.A.S. Centre for the Evaluation of the Effectiveness of Health Care, Modena Local Health Unit (Drs. Nonino, Baronciani, and Magrini); Department of Emergency Medicine, S. Orsola-Malpighi Hospital, Bologna (Dr. Re); Neuroradiology, Santa Maria Nuova Hospital, Reggio-Emilia (Dr. De Berti); Institute of Neurology, University of Parma (Dr. Manzoni); Pierantoni Hospital, Neurology Unit, Forlì Local Health Unit (Dr. Querzani); and Emergency Medicine, AUSL Forlì (Dr. Vandelli); Italy.

Address all correspondence to Prof. Pietro Cortelli, Dipartimento di Neuroscienze, Università di Modena e Reggio-Emilia, Via Dal Pozzo, 71, 41100 Modena, Italy.


Objective.—To provide to emergency department (ED) physicians with guidelines for diagnosis of patients with nontraumatic headaches.

Background.—Many patients present to an ED with the chief complaint of headache. Causes of nontraumatic headache include life-threatening illnesses, and distinguishing patients with such ominous headaches from those with a primary headache disorder can be challenging for the ED physician.

Conclusion.—We present a consensus statement aimed to be a useful tool for ED doctors in making evidence-based diagnostic decisions in the management of adult patients with nontraumatic headache.

Methods.—A multidisciplinary work performed an extensive review of the medical literature and applied the information obtained to commonly encountered scenarios in the ED.