Headache

Abstract

The most important step in the evaluation of headaches is to rule out underlying potentially serious secondary causes such as subarachnoid hemorrhage, meningitis, epidural or subdural hematoma, cerebral venous sinus thrombosis, pseudotumor cerebri, giant cell arteritis, and intracranial mass lesion.

History and physical examination provide very important clues to the diagnosis of these conditions. Constitutional symptoms and signs of meningismus should prompt further investigation with lumbar puncture/CSF analysis and features of neurological focality warrant brain imaging. One should be mindful that cluster headaches may produce an ipsilateral Horner’s syndrome without a structural lesion.

Once these pertinent secondary causes of headaches are ruled out, the primary headaches are classified mainly into migraine, tension-type headaches, and trigeminal autonomic cephalgias (which include cluster headaches and paroxysmal hemicrania, among others) and can be managed in the outpatient clinic once the patient is stable.