Management of primary headaches in adult Emergency Departments: a literature review, the Parma ED experience and a therapy flow chart proposal.

Adults seeking treatment at hospitals' Emergency Departments (EDs) because of headache represent a major health-care issue. To date, there are no special guidelines for management of primary headache in adults seen at EDs and therapeutic approaches are often inconsistent. This review describes the therapeutic strategies that are most frequently used to treat primary headache in adult ED patients and their in situ efficacy, based on literature data, the type of medications studied in randomized clinical trials for the management of adult ED patients, and the recommendations found in the guidelines for symptomatic treatment of migraine. We also report on the experience of the Parma University Hospital ED in the year 2007 for the management of adult patients diagnosed with primary headache. Finally, we propose an algorithm for primary headache management in ED patients, which is based on the literature data and clinical experience, and is suitable for application in Italy.