Migraine Diagnosis: Headache is a very common condition. The vast majority of headache resolves without need to consult a doctor. In primary care, the most commonly encountered headache disorders are:
- Tension-type Headache
- Chronic Daily Headache
- Cluster Headache
These are all Primary Headache Disorders and account for almost all headache.
Only a tiny proportion of headache is secondary in nature i.e. due to a more serious underlying pathology. However, there are certain symptoms indicative of sinister headache that GPs should watch out for that may need referral.
Eliminating Secondary headache
Warning signs that may indicate possible secondary headache:
- Sudden onset: Patients with a subarachnoid haemorrhage typically report having a sudden onset of severe headache
- The age of the patient: Temporal arthritis typically occurs in older people and is extremely rare in individuals younger than 50. Primary headache disorders usually begin at a much younger age
- Associated symptoms: Fever and neck stiffness may indicate Bacterial meningitis or Herpes simplex encephalitis. Mental deterioration, seizures, or weakness of the extremities or face may be symptoms of brain tumors.
- Recent head trauma: Headaches soon after trauma to the head may be caused by subdural or epidural hematomas.
- Worst headache
- Triggered by coughing / sneezing
- Repetitive / Long-lasting / Non-spreading aura
- Persistent headache in children
- Occipital headache in association with uncontrolled hypertension
- Signs or symptoms of ongoing neurological deficit between headaches
I.H.S Diagnostic Criteria
Once secondary headache has been ruled out, the next step is to make the correct diagnosis of primary headache. Headache diagnosis has been made easier by the International Headache Society (I.H.S.) Diagnostic guidelines, first published in 1988 and updated in 2004.