Skip to Main Content

++

Headache is a nearly universal symptom. As an example of the prevalence of headache, a study of 410 patients who had visited a primary care internal medicine practice found that headache was the fourth most common symptom and was exceeded only by fatigue, back pain, and dyspnea.1 In an early study of over 1 million unselected individuals from the general population, headache was the single most common current symptom and was reported by 39% of men and 56% of women.2 As physicians, nearly all of us have had personal experience with headache and can understand the headache descriptions that we hear from our patients. Chapter 17 elegantly details the prevalence of this common symptom and of common primary headache syndromes. Primary headaches are those without a pathologic basis.3–5 These are benign recurring headaches of unknown cause. The most common primary headache syndromes are migraine, tension-type, and cluster headache. Secondary headaches are the result of an underlying pathologic cause.

++

When faced with the large numbers of patients who seek medical evaluation for headache, clinicians seek to identify the rare patient with a serious headache from the rest whose headache is benign in nature. Two general approaches assist this effort. Firstly, one must learn the warning symptoms and signs that suggest a pathologic cause for headache. Many published reviews have offered such advice.4,6,7 A complementary approach is to learn to confidently diagnose benign primary headache syndromes through careful history taking and the systematic application of established diagnostic criteria. Primary headaches are clinical diagnoses that are based on history taking alone. With the exception of the occasional persistence of a partial Horner’s syndrome among asymptomatic patients with a history of cluster headaches, the physical examination of a patient with primary headaches is normal during headache-free intervals.

++

The most commonly used criteria are the International Headache Society (IHS) classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain.8 The use of these criteria helps to identify uniform populations of patients for research and epidemiologic studies. The criteria themselves, however, are complicated, not easily committed to memory, and may be unnecessarily restrictive in the daily clinical care of patients.

++

When evaluating individual patients with headache, clinicians will benefit from understanding which historical features are most useful in establishing or excluding a particular primary headache diagnosis. In this chapter, I review and summarize published clinical series of patients with migraine, tension-type headache, and cluster headache to determine the sensitivity, specificity, and likelihood ratios of individual historical features.

++

Clinicians may initially classify all headaches as either old or new. Old headaches are similar to those that have occurred repeatedly over time. Primary headaches are old headaches. New headaches are either headaches of recent onset or those that represent a change in the character or pattern of an old headache. A new headache may ultimately prove to be the first instance ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.