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Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by methodical review of available evidence and consensus among committee members.   

Algorithms associated with this Clinical Pathway: 

Inclusion criteria 


  • Bilateral frontal or occipital headache that worsens in the upright position and improves in the supine position.  
  • Nausea, dizziness, neck pain, visual changes and occasionally tinnitus.
  • Hearing loss or radicular symptoms into the arms.  
  • Symptoms, especially headache, may also be worse with coughing and Valsalva maneuver, even in the supine position. 

Team members involved in the development: 

  • A. Booser MD | Anesthesiology | Committee co-chair 
  • A. Morel MD | Anesthesiology | Committee co-chair 
  • E. Scott DO | Emergency Medicine | Committee member 
  • S. Jain MD | Emergency Medicine | Committee member 
  • T. Glenski MD | Evidence Based Practice Department & Anesthesiology | Committee member 
  • J. Bartlett PhD, RN | Evidence Based Practice Department | Committee member 

Publication dates: 

  • Finalized date: Dec. 6, 2021 
  • Next expected revision date: December 2024 

Concerns with content:

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These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.