Evaluation of headache in adults
- Zahid H Bajwa, MD
Zahid H Bajwa, MD
- Tufts University Medical School
- R Joshua Wootton, MDiv, PhD
R Joshua Wootton, MDiv, PhD
- Assistant Professor
- Harvard Medical School
Headache is among the most common medical complaints. An overview of the approach to the patient with headache is presented here. The approach to adults presenting with headache in the emergency department is reviewed elsewhere. (See "Evaluation of the adult with headache in the emergency department".)
The clinical features and management of specific primary headache syndromes are discussed separately. (See "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults" and "Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis" and "Cluster headache: Epidemiology, clinical features, and diagnosis".)
EPIDEMIOLOGY AND CLASSIFICATION
As many as 90 percent of all benign headaches fall under a few categories, including migraine, tension-type, cluster, and chronic daily headache. While episodic tension-type headache is the most frequent headache type in population-based studies, migraine is the most common diagnosis in patients presenting to primary care physicians with headache. The one-year prevalence of episodic tension-type headache (TTH) is approximately 65 percent (see "Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis", section on 'Epidemiology'), but most people with tension-type headache do not present to physicians for care. As an example, a study of two primary care units in Brazil found that migraine was the most prevalent primary headache disorder, accounting for 45 percent of patients reporting headache as a single symptom .
Cluster headache typically leads to significant disability and most of these patients will come to medical attention. However, cluster headache remains an uncommon diagnosis in primary care settings because of overall low prevalence in the general population (<1 percent). (See "Cluster headache: Epidemiology, clinical features, and diagnosis", section on 'Epidemiology'.)
Clinicians can easily become familiar with the most common primary headache disorders and how to distinguish them (table 1).
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- EPIDEMIOLOGY AND CLASSIFICATION
- Tension-type headache
- Cluster headache
- Secondary headache
- History and examination
- Danger signs
- Other features suggesting a secondary headache source
- Diagnostic instruments
- Indications for imaging studies
- Indications for lumbar puncture
- PATIENT SETTINGS
- Sudden onset
- New or recent onset headache
- Chronic headache
- Older patients
- Traumatic brain injury
- Sinus symptoms
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS