The challenge of headache management in the hospital can be divided into the diagnostic and management issues encountered in the emergency department, and the issues involved in the inpatient management of chronic refractory headaches. The two endeavors are different but linked because of overlapping diagnostic and treatment options. In addition, the problem of the intractable acute headache encountered in the emergency department can evolve into inpatient care of the same patient who has failed to respond to acute treatment. Here the author presents an approach to the patient with severe acute headache in the emergency department and explores the options available for managing intractable headaches in the inpatient setting.
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