Abstract

This systematic review aimed to assess the effectiveness of various treatment approaches utilized in emergency rooms to manage severe primary headaches. PRISMA criteria were followed in the course of this investigation. The treatment of severe headaches in the emergency department (ED) was the subject of a comprehensive search on the databases MEDLINE, EMBASE, and Cochrane, which covered the years 2014-2024. The relevant literature references were searched manually to find further research which was not found in the electronic search. This systematic review comprised seven investigations; two were conducted in Turkey, two in Iran, and three in the United States. In three investigations, the effects of lidocaine solution were evaluated; in the others, the effects of sodium valproate and ibuprofen, bupivacaine on the blockade of the greater occipital nerve and sphenopalatine ganglion and acetaminophen were examined. Two studies employed a numerical rating scale, four researchers used a visual analog scale, and one study used a 0-10 scale to quantify pain. Intranasal lidocaine is a useful treatment option for ED patients with severe headaches. Sodium valproate was more effective in the ED at reducing severe headaches. Greater occipital nerve blocks could be a helpful treatment for patients with acute migraine in the ED. Acute severe headaches treated with IV acetaminophen, prochlorperazine, and diphenhydramine in the ED resulted in statistically significant pain relief.

Key words: Severe headache, management, emergency department, acute, systemic review