Pearls: Headache

ABSTRACT

Distinguishing primary headache from secondary headache is the first objective of every new clinical encounter with a patient complaining of headache. The history is king in headache medicine—90% of patients presenting with headache have a primary headache disorder and the examination is normal. The history must be elicited because patients will not always volunteer seminal information. A standard series of questions must be asked of each patient to guide an appropriate diagnostic evaluation and ensure that secondary causes are not overlooked. The second objective, of course, is making the correct diagnosis of the primary headache disorder. Although at first glance this appears obvious and almost patronizing, making the correct diagnosis is often not a priority, nor is it a process that is emphasized in undergraduate and postgraduate training programs. Knowing some simple rules and standard questions will make the process almost fail proof.

KEYWORDS

Headache - diagnosis - treatment

REFERENCES

• 1 Headache Classification Committee of the International Headache Society . The International Classification of Headache Disorders (second edition).  Cephalalgia. 2004;  24(S1) 1-160
• 2 Richard A, van den Maagdenberg A M, Jen J C et al.. C-terminal truncations in human 3′-5′ DNA exonuclease TREX1 cause autosomal dominant retinal vasculopathy with cerebral leukodystrophy.  Nat Genet. 2007;  39 1068-1070
• 3 Schwedt T J, Matharu M S, Dodick D W. Thunderclap headache.  Lancet Neurol. 2006;  5(7) 621-631
• 4 Dodick D W, Silberstein S D. Migraine prevention.  Pract Neurol. 2007;  7(6) 383-393