Migraine Resource Network is a comprehensive educational initiative for clinicians seeking current and emerging information on migraine headache. Our mission is to provide ongoing medical education that embodies evidence-based scientific data, current treatment strategies, and the insightful knowledge of expert faculty. Our goal is to support your ongoing dedication to optimizing treatment outcomes for your patients.

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Diagnosis of Headache in the Emergency Department

Release Date: December 31, 2008
Expiration Date: December 31, 2009


Program Overview

People with severe headaches frequently resort to an Emergency Department (ED) visit for acute treatment. Emergency practitioners are challenged to differentiate primary headache from headache arising from a secondary cause. Various types of headache can present in similar fashion and one may mimic another, yet treatment options may be very different, and consequences of secondary headache are life threatening.

Comprehensive intake from the patient, neurologic assessment and differentiation of headache are all essential actions required when formulating an accurate diagnosis, patient triage, and treatment in the emergency setting. Understanding the phenomenon known as aura in the context of both primary migraine and its similar appearance and characteristics associated with secondary morbid conditions is an important factor in expediting a diagnosis and safely initiating therapy for prompt pain relief. Without historic knowledge of the patient, atypical findings must be biased toward serious etiologies, until proven otherwise.

This expert commentary is designed to improve clinical outcomes by improving the awareness and performance skills of practitioners charged with conducting a diagnostic work-up on patients with severe headache in the ED.

Target Audience

This activity is designed for Emergency Department physicians.

Learning Objectives

After completion of this educational activity, participants will be able to:

  1. Differentiate various types of headaches by symptoms encountered in patients who present to the ED for acute treatment.
  2. Contrast and compare aura in patients with migraine and in those with headache of a secondary origin.
  3. Describe diagnostic methodologies used to improve differentiation of headache in patients who present to the ED.

General Information

This activity is eligible for credit through December 31, 2009. After this date, this activity will expire and no further credit will be awarded.

Expected time to complete this activity as designed: 30 minutes

There are no fees for participating in this activity. All participants must complete the Activity Evaluation Form. Participants must receive a minimum score of 70% on the self-assessment portion of the form to qualify for CE credit. Certificates may be printed immediately after successfully completing the online self-assessment and evaluation.

Faculty Biography

R. Allan Purdy MD, FRCPC, FACP
Professor of Medicine, Dalhousie University
Professor and Head, Department of Medicine
Chief, Medicine Service
Queen Elizabeth Health Sciences Centre
Dalhousie and Capital Health
Halifax, Nova Scotia

Dr. R. Allan Purdy is a professor of medicine (neurology) at Dalhousie University. He is also professor and head of the Department of Medicine, and chief of the Medicine Service at Queen Elizabeth Health Sciences Centre of the Department of Medicine at Dalhousie and Capital Health, Halifax, Nova Scotia.

Dr. Purdy is past-president of the Canadian Headache Society and is a member of the American and the International Headache Societies. He is on the editorial boards of Cephalalgia and Headache, and is a member of the education committees of the American Headache Society and International Headache Society, is on the Board of Directors of the American Headache Society, and recently directed education courses as a member of the Scientific Program Committee of the International Headache Congress in Kyoto in 2005, and Stockholm in 2007. He is the 2010 incoming chair of the Scientific Program Committee of the American Headache Society.

He has received Excellence in Teaching Awards from his department and university on numerous occasions as well as an Instructional Leadership Award from the Association of Atlantic Universities in Atlantic Canada. He is the 2001 recipient of the Award for Outstanding Contribution to Continuing Medical Education from Dalhousie University.

Dr. Purdy was a co-author of the Canadian “Guidelines for the Management of Migraine in Clinical Practice,” published in the Canadian Medical Association Journal in 1997 and 1998. He is actively involved in clinical trial research in migraine and has several papers and publications. He is also co-editor of Advanced Therapy of Headache with the second edition in 2005. He is the 2005 recipient of the Arnold P. Friedman Distinguished Clinician Research Award from the American Headache Society for outstanding contribution to the field of headache, and the 2007 Lifetime Achievement Award from the Headache Cooperative of New England. Dr. Purdy has been named one of the Best Doctors in Canada in 2008. He has been recently elected as a fellow of the American College of Physicians.


MediCom LogoAccreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of MediCom Worldwide, Inc. and Medical Learning Solutions. MediCom Worldwide, Inc. is accredited by the ACCME to provide continuing medical education for physicians.
Designation Statement: MediCom Worldwide, Inc. designates this educational activity for a maximum of
0.5 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


In accordance with the Accreditation Council for Continuing Medical Education (ACCME), ACPE and California Board of Nursing, MediCom Worldwide, Inc. requires that all program planners, faculty, and providers who are in a position to control the content of a CE activity are required to disclose any relevant financial relationships they may have or have had within the last 12 months with the commercial supporter or the manufacturer(s) of any commercial device(s) discussed in this educational activity. Accordingly the following disclosures were made.

Faculty Disclosure

Dr. R. Allan Purdy has disclosed that he has no significant relationships with the grantor Endo Pharmaceuticals, Inc. or any other commercial company whose products and services may be related to his presentation.

Planner and Provider Disclosures

The individuals listed below from MediCom Worldwide, Inc. reported the following for this activity: Joan Meyer, executive director; Norma Jean Talley, manager, professional education; and Ruth Widmer, medical editor, have nothing to disclose.

Off-Label/Investigational Disclosure

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Dr. Purdy indicated that his presentation would not include the discussion of unlabeled uses of commercial products or investigational products not yet approved by the FDA for any use in the United States.

Conflict of Interest Resolution

To resolve identified conflicts of interest, the educational content was fully peer reviewed by members of the MediCom Content Review Committee. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced.

This activity is supported by an educational grant from
Endo Pharmaceuticals.

©2008 MediCom Worldwide, Inc., 101 Washington St., Morrisville, PA 19067. No portion of this material may be copied or duplicated without written permission of MediCom.

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