Evaluation and management of headache in primary care

Headache disorders are ubiquitous, common, disabling and to a very large extent treatable in primary care. In this review, the important headache disorders are described together with their impact on public health. Suggestions are set out for their optimal management, although many of these are necessarily based more on expert opinion than on formal evidence, since clinical trials have covered only narrow areas of headache treatment. Most people whose lives are adversely affected by headache disorders benefit from drug interventions, either acute or preventative, but other forms of treatment are always important and should never be overlooked. An important disorder is entirely iatrogenic: its recognition is crucial to its effective management, which requires medication withdrawal. Future research is needed not only into the mechanisms of headache causation, as a prerequisite for the development of better treatments, but also into public health aspects seeking an explanation of (and remedy for) the low priority given worldwide to headache-related healthcare despite the severe human and socioeconomic consequences.