Assistant Professor of Neurology Harvard Medical School/Mass General Brigham/Atrius Health Harvard Medical School Sharon, Massachusetts
Headache is one of the most common complaints among patients presenting to primary care, neurology, and pain practice. The evaluation, diagnosis, and treatment of headache can be rather cumbersome, and at times quite challenging for even the most seasoned clinician. Many factors, although not causative, can play an exacerbating role in the genesis of headaches. These factors include stress, sleep dysfunction, hormonal fluctuations, weather fluctuations, psychiatric co-morbidieties, and co-morbid pain conditions. In this lecture, the essential elements of a headache evaluation will be addressed including headache-specific history, physical examination, warning signs of secondary headache disorders, and when to consider further testing. The lecture also includes a review of the diagnostic criteria for primary headache disorders according to the International Headache Society’s International Classification of Headache Disorders, 3rd Edition (ICHD-3). There will be a focus on migraine, which is the most common diagnosis among patients presenting with a primary complaint of headache with a prevalence in the general population of 1 in 5 women and 1 in 20 men. Migraine is highly underdiagnosed, and thus a diagnosis for which most people do not receive adequate treatment.
Learning Objectives:
Accurately classify headaches based on International Headache Society Criteria
Discuss unmet needs in the primary care, women’s health, and emergent care settings
Describe how to improve the quality of migraine treatment across diverse patient populations
Identify red flags in the history and physical examination that would suggest a secondary headache disorder
Choose appropriate studies for further evaluation based on patient history and physical findings
