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Objective  Little is known about the presentation or management of patients with headache in the out‐of‐hospital setting. Our primary objective is to describe the out‐of‐hospital assessment and treatment of adults with benign headache. We also describe meaningful pain reduction stratified by commonly administered medications.    Methods  This retrospective evaluation was conducted using data from a large national cohort. We included all 911 responses by paramedics for patients 18 and older with headache. We excluded patients with trauma, fever, suspected alcohol/drug use, or who received medications suggestive of an alternate condition. We presented our findings with descriptive statistics.    Results  Of the 5,977,612 emergency responses, 1.1% (66,235) had a provider‐documented primary impression of headache or migraine and 52.5% (34,763) met inclusion criteria. An initial pain score was recorded for 73.5% (25,544) of patients, and 58.5% (14,948) of these patients had multiple pain scores documented. Of the patients with multiple pain scores documented, 53.8% (8037) of patients had an initial pain score >5. Of these, 7.1% (573) were administered any medication. Among patients receiving a single medication, Fentanyl was the most commonly administered (32.1%, 126). As a group, opioids were the most commonly administered class of drugs (38.9%, 153) and were associated with the largest proportion of clinically significant pain reduction (69.3%, 106). Dopamine antagonists were given least frequently (9.9%, 39) but had the second largest proportion of pain reduction (43.6%, 17).    Conclusion  Out‐of‐hospital pain scores were documented infrequently and less than one in five patients with initial pain scores >5 received medication. Additionally, adherence to evidence‐based guidelines was infrequent.

Out‐of‐hospital assessment and treatment of adults with atraumatic headache