Headache is common. There are many different types of headache. Accurately diagnosing headache depends on a detailed history and a targeted examination.
- Distinguish between primary and secondary headaches when establishing an accurate diagnosis.1
- Take a comprehensive history, and perform careful, targeted physical and neurological examinations.1
- 'Red flag' symptoms and signs indicate the need for investigation, such as neuroimaging.
Refer to the diagnostic criteria for the three most common types of primary headache: episodic tension-type, migraine and cluster.2 People often experience episodes of both tension-type and migraine headaches. There are no diagnostic tests for primary headache. Most are benign and investigations are not usually needed.
Neuroimaging is not needed for people with a normal neurological examination and without any red-flag symptoms.
Know and look for red flags when diagnosing headaches
Consider secondary headache in anyone with new onset acute headache, or a headache that is different from their usual headache.1 Red-flag symptoms and signs together with an abnormal neurological examination indicate the need for specialist referral for further investigation, such as neuroimaging.1
- British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type headache, cluster headache and medication overuse headache. Hull: 2010. http://18.104.22.168/upload/NS_BASH/2010_BASH_Guidelines.pdf (accessed 21 June 2012).
- Rossi S, ed. eAMH [online]. Australian Medicines Handbook 2010. Adelaide: Australian Medicines Handbook, January 2010.