Clinical management of young patients presenting with headache

Headache is a common symptom in young patients and requires a clearly structured, individual approach. The history and the clinical examination are prerequisites for planning further management of the condition. The IHS classification is particularly useful in the differential diagnosis of idiopathic headache. Additional diagnostic testing should not be performed routinely, but on an individual basis depending on the patient's history and neurological findings. The acute therapy of idiopathic headache in young patients has been evaluated in few studies only. However, there is general agreement that (in subjects requiring medication) paracetamol, acetylsalicylic acid and ibuprofen are most useful for treating migraine attacks, whereas analgesics should widely be avoided in tension-type headache. For the prophylaxis of migraine and tension-type headache, non-pharmacological measures such as regulation of lifestyle, relaxation training and psychological or psychotherapeutic interventions are much more important than pharmacotherapy, which is required in a small number of patients only.