Paul G. Mathew, M.D.,1,2 and Ivan Garza, M.D.3
KEYWORDS: Primary headache, migraine, trigeminal autonomic cephalgias, cluster headache, tension-type headache
EVALUATIONThe ﬁrst major step that a neurologist must take when evaluating a headache patient in an outpatient neurology practice is to establish whether the headache is a ‘‘primary’’ or ‘‘secondary’’ type ofheadache. Primary headaches are those that cannot be attributed to an underlying disorder, whereas secondary headaches are due to a speciﬁc underlying cause or disorder. In the case of secondaryheadaches, addressing the underlying disorder can often, but not always, lead to resolution of the headaches. Some of the common causes of secondary headaches are listed in Table 1.
History The mostfundamental and essential component in the evaluation of headaches is a thorough history. Table 2 summarizes the important elements of a headache hisDepartment of Neurology, Brigham and Womens FaulknerHospital, John R. Graham Headache Center, Jamaica Plain, Massachusetts; 2 Division of Neurology, Cambridge Health Alliance, Cambridge, Massachusetts; 3Department of Neurology, Mayo Clinic, Rochester,Minnesota. Address for correspondence and reprint requests: Paul G. Mathew, M.D., John R. Graham Headache Center, 1153 Centre Street, Suite 4970, Jamaica Plain, MA 02130 (e-mail: PMATHEW@partners.org).
1tory. The history should be chronological, and should document the evolution of all associated symptoms. It is vital to have the patient recall when the headaches began, and whether there were anytriggering events around the time of onset. Events such as head trauma, the presence of infectious diseases or inﬂammatory processes, and other neurologic disorders can all be associated with thedevelopment of headaches. Other details that should be elicited include the location, radiation, quality, frequency, and duration of pain. For female patients with headaches, seeking any prior or...