Headache in the emergency department: Sex differences in triage, diagnostic evaluation, and treatment.

Cross-sectionalCephalalgia : an international journal of headache· Jul 2026

Headache in the emergency department: Sex differences in triage, diagnostic evaluation, and treatment.

Cornelius Angerhöfer, Carolin Luisa Hoehne, Mira Pauline Fitzek … Bianca Raffaelli

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Emergency MedicineCross-sectionalClinical practiceQ1IF 5.1

Men with headache had higher odds of secondary headache from serious pathology

Headache in the emergency department: Sex differences in triage, diagnostic evaluation, and treatment.

Cornelius Angerhöfer … Bianca Raffaelli

Cephalalgia · Jul 2026 · Q1 in General Medicine

Background

Headache is a common neurological complaint in emergency departments (emergency departments).

Purpose

This study examined sex differences across the emergency care pathway among patients presenting with headache.

Methods

We conducted a cross-sectional observational study of adult patients presenting with headache to a large university hospital emergency departments between 5 May 2023, and 5 May 2025.

n = 1825 adults

Results

men more often had a dangerous underlying cause for their headache

AOR by subgroup · 95% CI

More results

Among 95,150 emergency departments presentations during the study period, 1825 adults (1.9%) presented with headache (61.9% women; mean age 48.5 ± 19.7 years).

Women were more frequently assigned higher-urgency triage categories, whereas male sex was associated with lower odds of higher-urgency triage (aOR 0.79, 95% CI 0.62-0.99).

More results

Use of cranial CT and lumbar puncture did not differ by sex, while men had lower odds of cranial MRI (aOR 0.48, 95% CI 0.26-0.90).

Women more often received repeated non-opioid analgesics (aOR 1.60, 95% CI 1.06-2.44) and antiemetics (aOR 1.69, 95% CI 1.16-2.45).

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Conclusion · 1 of 3

Sex differences in emergency headache care emerge early in the clinical pathway.

Conclusion · 2 of 3

Lower perceived urgency despite a higher likelihood of serious pathology among men suggests a potential mismatch between triage assessment and underlying clinical risk.

Conclusion · 3 of 3

These findings highlight the need to further evaluate sex-related factors in triage and diagnostic pathways for patients presenting to the emergency departments with headache.

Headache in the emergency department: Sex differences in triage, diagnostic evaluation, and treatment.

Headache in the emergency department: Sex differences in triage, diagnostic evaluation, and treatment.

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