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Management of headache patients
Grazia Sances1, Teresa Catarci
1National Institute of Neurology "C. Mondino" Foundation, IRCCS Via Mondino, Pavia, Italy. grazia.sances@mondino.it
Handbook of Clinical Neurology
|September 7, 2010
Summary
Accurate headache diagnosis relies on clinical evaluation and detailed patient history, not routine testing. Clinicians should carefully assess headache characteristics and history to differentiate primary from secondary causes.
Area of Science:
- Neurology
- Clinical Medicine
Background:
- Headaches are a frequent complaint in neurological practices, posing diagnostic challenges.
- Approximately 20% of outpatients in neurology clinics present with headache disorders.
- Intractable or potentially secondary headaches require careful clinical evaluation.
Purpose of the Study:
- To emphasize the diagnostic approach to headaches in clinical practice.
- To guide clinicians in differentiating primary and secondary headache types.
- To highlight the importance of thorough patient history in headache diagnosis.
Main Methods:
- Clinical assessment based on comprehensive patient history.
- Detailed questioning regarding headache onset, temporal profile, and attack characteristics.
- Systematic inquiry into medical, gynecological, psychological, and family history.
- Careful screening for signs suggestive of secondary headaches.
Main Results:
- Diagnosis of probable primary headache can often be established through history alone.
- Clinical guidelines recommend diagnostic testing only when secondary causes are strongly suspected.
- Thorough history taking is crucial for identifying potential red flags for secondary headaches.
Conclusions:
- Headache diagnosis is primarily clinical, emphasizing patient history over diagnostic tests.
- Systematic evaluation is essential to rule out secondary headaches before considering comorbidities.
- Appropriate management may involve lifestyle modifications after excluding serious underlying conditions.
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