The Medical History: The Key to Correct Headache Diagnosis

  • E. Anne MacGregor
  • K. Ravishankar
  • David Dodick
Reference work entry


Effective management of headache depends on correct diagnosis. The presence of warning symptoms should necessitate further investigation to rule out an underlying cause. Once pathology has been excluded, targeted questions and pattern recognition of typical presentations of headache enable more confident diagnosis. With primary headaches being more common in practice than secondary headaches, correct diagnosis is dependent on a good history. A good history is also important to prevent misdiagnosis when there are coexisting headache types.


Subarachnoid Hemorrhage Cluster Headache Intracranial Aneurysm Arteriovenous Malformation Migraine With Aura 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Bahra A, Goadsby PJ (2004) Diagnostic delays and mis-management in cluster headache. Acta Neurol Scand 109:175–179PubMedCrossRefGoogle Scholar
  2. Bille B (1997) A 40-year follow-up of school children with migraine. Cephalalgia 17:488–491PubMedCrossRefGoogle Scholar
  3. Blau JN (1993) Behaviour during a cluster headache. Lancet 342:723–725PubMedCrossRefGoogle Scholar
  4. Blau JN, MacGregor EA (1995) Migraine consultations: a triangle of viewpoints. Headache 35:104–106PubMedCrossRefGoogle Scholar
  5. Bone I, Fuller G (2002) Headache. J Neurol Neurosurg Psychiatry 72(Suppl 2):ii1PubMedGoogle Scholar
  6. Detsky ME, McDonald DR, Baerlocker MO, Tomlinson GA, McCory DC, Booth CM (2006) Does this patient with headache have a migraine or need neuroimaging? J Am Med Assoc 296:1274–1283CrossRefGoogle Scholar
  7. Dodick DW (2010) Pearls: headache. Semin Neurol 30(1):74–81PubMedCrossRefGoogle Scholar
  8. Fitzpatrick R (1996) Telling patients there is nothing wrong. BMJ 313:311–312PubMedGoogle Scholar
  9. Giffin NJ, Ruggiero L, Lipton RB, Silberstein SD, Tvedskov JF, Olesen J, Altman J, Goadsby PJ, Macrae A (2003) Premonitory symptoms in migraine: an electronic diary study. Neurology 60:935–940PubMedGoogle Scholar
  10. Hamilton W, Kernick D (2007) Clinical features of primary brain tumours: a case-control study using electronic primary care records. Br J Gen Pract 57:695–699PubMedGoogle Scholar
  11. Headache Classification Subcommittee of the International Headache Society (IHS) (2004) The international classification of headache disorders (2nd edn.). Cephalalgia 24:1–160Google Scholar
  12. Howard L, Wessely S, Leese M, Page L, McCrone P, Husain K, Tong J, Dowson A (2005) Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. J Neurol Neurosurg Psychiatry 76:1558–1564PubMedCrossRefGoogle Scholar
  13. Latinovic R, Gulliford M, Ridsdale L (2006) Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurol Neurosurg Psychiatry 77:385–387PubMedCrossRefGoogle Scholar
  14. Laughey WF, MacGregor EA, Wilkinson MI (1993) How many different headaches do you have? Cephalalgia 13:136–137PubMedCrossRefGoogle Scholar
  15. Lipton RB, Stewart WF, Simon D (1998) Medical consultation for migraine: results from the American migraine study. Headache 38:87–96PubMedCrossRefGoogle Scholar
  16. Lipton RB, Dodick D, Sadovsky R, Kolodner K, Endicott J, Hettiarachchi J, Harrison W (2003) A self-administered screener for migraine in primary care: the ID migraine validation study. Neurology 61:375–382PubMedGoogle Scholar
  17. MacGregor A, Frith A (eds) (2008) ABC of headache. BMJ Books, LondonGoogle Scholar
  18. MacGregor EA, Steiner TJ, Davies PTG (2010) Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type, cluster and medication-overuse headache. Available at: Accessed 31 Jan 2011
  19. Stewart WF, Wood C, Reed ML, Roy J, Lipton RB (2008) Cumulative lifetime migraine incidence in women and men. Cephalalgia 28:1170–1178PubMedCrossRefGoogle Scholar
  20. van Vliet JA, Eekers PJ, Haan J, Ferrari MD (2003) Features involved in the diagnostic delay of cluster headache. J Neurol Neurosurg Psychiatry 74:1123–1125PubMedCrossRefGoogle Scholar
  21. Vazquez-Barquero A, Ibanez FJ, Herrera S, Izquierdo JM, Berciano J, Pascual J (1994) Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia 14:270–272PubMedCrossRefGoogle Scholar
  22. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828PubMedCrossRefGoogle Scholar
  23. Weingarten S, Kleinman M, Elperin L, Larson EB (1992) The effectiveness of cerebral imaging in the diagnosis of chronic headache. Arch Intern Med 152:2457–2462PubMedCrossRefGoogle Scholar

Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  • E. Anne MacGregor
    • 1
  • K. Ravishankar
    • 2
  • David Dodick
    • 3
  1. 1.The City of London Migraine ClinicLondonUK
  2. 2.The Headache and Migraine ClinicJaslok Hospital and Research Centre, Lilavati Hospital and Research CentreMumbaiIndia
  3. 3.Department of NeurologyMayo Clinic ArizonaPhoenixUSA

Personalised recommendations