Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Evaluation of headache in adults

Zahid H Bajwa, MD
R Joshua Wootton, MDiv, PhD
Section Editor
Jerry W Swanson, MD
Deputy Editor
John F Dashe, MD, PhD


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".)


As many as 90 percent of all benign headaches fall under a few categories, including migraine, tension-type, and cluster headache. While a population-based study found that the one-year prevalence of episodic tension-type headache was 38 percent [1], most of these people 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 [2].

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 headache disorders and how to differentiate between them (table 1). It is not necessary to follow the detailed classification and diagnostic criteria proposed by the International Headache Society (IHS), although there are certain important points that should be kept in mind whenever describing, managing, or discussing patients with headache:


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Apr 2015. | This topic last updated: Dec 10, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
  1. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998; 279:381.
  2. Bigal ME, Bordini CA, Speciali JG. Etiology and distribution of headaches in two Brazilian primary care units. Headache 2000; 40:241.
  3. Gil-Gouveia R, Martins IP. Headaches associated with refractive errors: myth or reality? Headache 2002; 42:256.
  4. Buring JE, Hebert P, Romero J, et al. Migraine and subsequent risk of stroke in the Physicians' Health Study. Arch Neurol 1995; 52:129.
  5. Hagen K, Stovner LJ, Vatten L, et al. Blood pressure and risk of headache: a prospective study of 22 685 adults in Norway. J Neurol Neurosurg Psychiatry 2002; 72:463.
  6. Law M, Morris JK, Jordan R, Wald N. Headaches and the treatment of blood pressure: results from a meta-analysis of 94 randomized placebo-controlled trials with 24,000 participants. Circulation 2005; 112:2301.
  7. Lipton RB, Diamond S, Reed M, et al. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache 2001; 41:638.
  8. Barbanti P, Fabbrini G, Pesare M, et al. Unilateral cranial autonomic symptoms in migraine. Cephalalgia 2002; 22:256.
  9. Cady RK, Schreiber CP. Sinus headache: a clinical conundrum. Otolaryngol Clin North Am 2004; 37:267.
  10. Maizels M, Burchette R. Rapid and sensitive paradigm for screening patients with headache in primary care settings. Headache 2003; 43:441.
  11. Edmeads J. Emergency management of headache. Headache 1988; 28:675.
  12. Lipton RB, Bigal ME, Steiner TJ, et al. Classification of primary headaches. Neurology 2004; 63:427.
  13. Lynch KM, Brett F. Headaches that kill: a retrospective study of incidence, etiology and clinical features in cases of sudden death. Cephalalgia 2012; 32:972.
  14. Shindler KS, Sankar PS, Volpe NJ, Piltz-Seymour JR. Intermittent headaches as the presenting sign of subacute angle-closure glaucoma. Neurology 2005; 65:757.
  15. Goadsby PJ. To scan or not to scan in headache. BMJ 2004; 329:469.
  16. Tsushima Y, Endo K. MR imaging in the evaluation of chronic or recurrent headache. Radiology 2005; 235:575.
  17. You JJ, Gladstone J, Symons S, et al. Patterns of care and outcomes after computed tomography scans for headache. Am J Med 2011; 124:58.
  18. Dumas MD, Pexman JH, Kreeft JH. Computed tomography evaluation of patients with chronic headache. CMAJ 1994; 151:1447.
  19. Silberstein SD, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache. Neurology 2000; 54:1553.
  20. Kumar KL, Cooney TG. Headaches. Med Clin North Am 1995; 79:261.
  21. Kent DL, Haynor DR, Longstreth WT Jr, Larson EB. The clinical efficacy of magnetic resonance imaging in neuroimaging. Ann Intern Med 1994; 120:856.