[Neurologic diagnosis and therapy of headaches]

Headaches are a very common complaint for general practitioners and neurologists. When a regional cause has been excluded, the neurologist will class headaches according to the criteria of the International Headache Society. An estimate of the 1-year prevalence of migraine in adults is about 10-15%. First line treatment of migraine attacks consists in aspirin (1 g) with or without metoclopramide or nonsteroidal antiinflammatory drugs. Second line treatment consists in vasoconstrictors, ergotamine or triptans. Beta-blockers are used for first line prophylactic treatment of migraine. Tension-type headache is by far the most common form of headache with a prevalence ranging from 30% to 80% and is more prevalent in women than in men. Nonsteroidal antiinflammatory drugs and muscle relaxants are used for tension-type headache. The prevalence of cluster headache is about 0.1%. Acute treatment consists in inhalation of 100% oxygen at 7 liters/min using a facial mask for 15 minutes or subcutaneous sumatriptan (6 mg), at most twice daily. Chronic paroxysmal hemicrania is a rare type of cluster headache with an absolute effectiveness of indomethacin. Trigeminal neuralgia is rare. However, it is probably the most intense facial pain. Pharmacological treatment is based on carbamazepin. Surgical treatment may be proposed secondarily. In conclusion, the right diagnosis leads to the right treatment. Thus, daily chronic headaches due to drug overuse can be avoided.