What are the latest recommendations for assessing adult patients with acute nontraumatic headache?

BEEM Bottom Line

Why is this study important?

Why is this guideline and at least some of its recommendations important? This clinical practice guideline (CPG) supports the use of the Ottawa Subarrachnoid Head (SAH) rule to risk-stratify adult acute headache patients for possible SAH and confirms imaging recommendations that are evidence-based (i.e., 3+ generation computed tomography (CT) scanners can rule out SAH in patients with symptoms ≤ 6 hours). It also confirms that no single or combination of symptoms or signs can definitively rule in or rule out SAH. This CPG also strongly recommends against opioids as initial headache therapy in the emergency department (ED). Finally, it offers a less than strong endorsement for either lumbar puncture (LP) or CT angiography (CTA) after negative initial CT in a patient who still seems high risk.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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