The management of chronic headaches

Most patients who complain of recurrent headaches have migraine, muscle contraction headache, or both. At a patient's first office visit for headache, the family physician should carry out a physical and neurological examination. The type of headache and factors that can precipitate it may then be explained, and the patient should be advised to take only simple analgesics for pain, as soon as he recognizes the first symptom of headache. A daily diary can help reveal specific factors that precipitate the patient's headaches. He can also benefit from educational material, and be taught relaxation techniques to ease headache pain. At least one follow up office visit is necessary in order to emphasize and review instructions from the previous assessment, and to give the patient an opportunity to consider the explanation and problems and voice any remaining concerns or questions.