Headache Diagnosis and History
Since most headache patients have normal neurologic and physical examinations, the most important tool for making a correct headache diagnosis is a detailed and relevant history (Silberstein, 1992). The headache history also provides an opportunity to establish a rapport that will serve as the basis for an ongoing relationship.
Patients often have more than one type of headache or a change in headache pattern over time. We begin with the headache that is the greatest concern to the patient, the one that motivated the person to seek care. We then explore any other headache patterns and their evolution.
The most common diagnoses are tension-type headache and migraine and associated variants.
Headaches provoked by fever and hunger (missed meals) probably rank next in frequency, followed by those due to nasal and paranasal, ear, tooth, and eye disease. The headaches of meningitis, intracranial aneurysm, brain tumor, and brain abscess, though most important and singularly dramatic, are less common.
Age at Onset
Primary headaches often begin in childhood, adolescence, or the second or third decade of life. Headaches that begin after age 50 more frequently have an organic etiology, such as temporal arteritis, cerebrovascular disease, or tumor. Migraine often stops at menopause, but it occasionally starts at that time. Tension-type headaches can begin at any age. Hypnic headache often begins in the elderly.
Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.