The objective was to study the demographics, diagnostic procedures and therapies employed in order to provide guidelines to Emergency Department (ED) physicians. A six-month retrospective analysis of the records of all patients presenting with nontraumatic headache (NTH) to the EDs of the Province of Trieste was performed. Of 38,238 patients screened, 300 (0.8%) presented with NTH and 49.7% were referred to specialists. Patients were classified as having secondary headache (41.3%), primary headache (24.3%) and headache with no obvious source (NOS) (34.4%). One hundred and seventy patients were treated with mono- or polytherapy. Of 50 patients with migraine, 36 were treated with NSAIDs and 4 with triptans. 68.4% of patients were referred to a general practitioner and 31.6% were admitted. The frequency of NTH was lower than in other studies. NOS headache was frequent. Only 10% of migraineurs received triptans. Diagnostic and therapeutic guidelines for ED physicians are needed.