Headache Care.net

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Headache Care

Overview, Diagnosis, and Classification of Headache

Thursday, Apr 19 2007


Headache is one of the most common medical complaints of civilized humans, yet severe and chronic headaches are only infrequently caused by organic disease. In the United States, in 1 year, most of the population will have a headache and over 5% will seek medical aid; over 1% of physicians’ office visits and emergency department visits are primarily for headache (Silberstein and Silberstein, 1990). Most recurrent headaches are symptoms of a chronic primary headache disorder, but ophthalmologic problems, sinusitis, dental disorders, infection, brain tumor, cerebral hemorrhage, and meningitis may all present with headache. Headache pain of benign origin may be intense; headache pain of malignant origin may be mild.

Many patients fear that their headache is secondary to a serious medical problem and seek not only pain relief but also reassurance that they do not have a brain tumor or other life-threatening problem. For these reasons, every physician must be knowledgeable in the diagnosis and treatment of headache.

What makes headaches hurt? What are the underlying mechanisms of headache? How can headaches best be classified? These questions, basic to an understanding of headache, are discussed in detail throughout this book. The clinician who appreciates how and why headaches occur will proceed more directly to a specific diagnosis and an appropriate course of therapy.

The key to diagnosis is the history. If the physician thinks “analgesic” as soon as the patient describes headache, little will be accomplished. Pain and associated symptoms are subjective and must be described by the patient. Some patients are not good observers of their own complaints, even when those complaints are chronic. For individuals who have difficulty verbalising their symptoms, clinicians will need time to take a precise history.

Remember, then, that the diagnosis of headache often depends upon patients’ descriptions of their symptoms. It is helpful to discuss this dilemma directly with the patients and advise them that there are no precise clinical tests for many specific pain syndromes, including migraine headache, cluster headache, and the major neuralgias. Diagnostic tests help establish or exclude secondary disorders.

Stephen D Silberstein
Richard B Lipton
Donald J Dalessio

Revision date: Semenchuk, E. M., and Larkin, K. T.
Published with assistance from the foundation established in memory of Amasa Stone Mather of the Class of 1907, Yale College.

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