Pharmacotherapy for Primary Headache Disorders in the Emergency Department

Golden L. Peters, PharmD, BCPS


US Pharmacist. 2018;43(3):HS2-HS8. 

In This Article

Abstract and Introduction


Headache disorders are one of the most common reasons that patients present to the emergency department (ED). For proper patient care, it is vital for the headache to be differentiated as a primary or secondary headache disorder. Primary headaches are more common than secondary headaches; however, secondary headaches are potentially life-threatening, whereas primary headaches possess straightforward treatment regimens and benign long-term outcomes. Classifying primary headaches as tension-type, cluster, or migraine headache with or without aura will guide pharmacotherapy selection in the ED setting. The pharmacist can impact the clinical management of headache disorders by providing effective medication counseling, ensuring that the medication regimen has the appropriate indication and route, and monitoring for adverse effects of treatment.


Headache is one of the most frequent causes of presentation to the emergency department (ED). It is estimated that nearly 50% of adults worldwide are affected by headache disorders, making headaches the most prevalent pain disorder.[1] In the United States, headache is the fifth leading cause of ED visits, accounting for an estimated 5 million visits annually.[2] The majority of headaches presenting to the ED are primary headache disorders (tension-type, cluster, and migraine headaches). Overall, tension headaches are the most common type, cluster headaches are the least common type, and migraine headaches are the most disabling.[1] Migraine headaches are the most frequent headache type to present to the ED, and they are responsible for approximately $17 billion in direct and indirect healthcare costs annually in the U.S.[3]