Neurology

Headaches Clinical Guide

This Clinical Guide presents an overview of headache disorders. We outline a broad classification framework for practitioners, while reviewing key pearls for diagnosing individual patients. We walk you through the diagnostic criteria, tell you which patients require further testing, and cover treatment regimens for the various disorders.

The most important step in helping your headache patients is determining an accurate diagnosis. In these articles, you will be exposed to the pitfalls and pearls of accurately diagnosing headache disorders. We explore both the primary headaches and secondary headaches, as well as review ominous headache events. You’ll gain the knowledge to guide your patients through diagnosis, evaluation, and treatment of headache syndromes, while confidently soothing their anxieties. You will also be able to help patients recognize what might be triggering headaches and how to avoid these triggers. Once a diagnosis is established, you will be led through treatment options ranging from non-pharmacologic management steps to prophylactic and abortive medicine regimens.

Author: Robert Coni, DO, EdS

Editor: Shelley Jacobs, PhD

Peer Reviewer: Franz Wiesbauer, MD, MPH

35 Articles | Guide last updated - 31st Aug 2020

What are the primary headache disorders?

Headache is one of the most common patient complaints. This chapter will familiarize you with the International Classification of Headache Disorders and the possible causes of headache pain. We then review the diagnosis of three key primary headache types including migraines, tension headaches, and cluster headaches, and briefly review other primary headache disorders and chronic daily headaches.

A look at the secondary headache disorders

Secondary headaches are classified into eight broad categories. In these articles we’ll review how to diagnose a number of common secondary headaches which include sinus headaches, headaches from musculoskeletal pain or temporomandibular joint (TMJ) issues, cranial neuralgias, and analgesic overuse headaches. Most importantly, we’ll summarize concerning red flag symptoms and the ominous headache syndromes that require immediate intervention. We’ll also take a look at underlying medical conditions that can also cause secondary headaches.

Characterizing your patient's headache

In the articles of this chapter we delve deeper into the essential details for mastering the diagnosis of headaches. We’ll walk you through characterizing your patient’s headaches by asking the appropriate questions and taking a great headache history. We’ll then look at using a headache diary to help your patient identify food and non-food triggers of headaches.

Completing a thorough exam for your headache patient

Every headache patient will require a full neurological examination. In these articles we’ll briefly cover the components of a complete neurological exam and we’ll look at possible neurological abnormalities that might be found upon examination. We’ll also review when it is appropriate to send your headache patient for imaging or further testing.

How to approach treatment for your headache patient

Once you accurately diagnose your headache patient, they’ll require a comprehensive treatment plan. In these articles we’ll review what you need to know about non-pharmacologic management, prophylactic medication, abortive medication, and rescue medications. We’ll wrap up this Headaches Clinical Guide by reviewing some patient cases where we’ll walk you through history taking, diagnosis, and treatment.