Clinical Management of Headaches

Introduction

It has been estimated that from 60 to 70 million Americans have experienced some form of headache. According to the National Headache Foundation, 42 million Americans (28 million of whom are women) suffer from migraine and related headache disorders, with at least one affected person in as many as 25% of households. Perhaps most distressingly, more than 4 million adults suffer from chronic migraine (more than 15 attacks per month). As these data illustrate, headache is one of the more prevalent problems to be confronted by the practicing physician.

Many headache sufferers will not consult a physician for the occasional tension-type headache. However, it is estimated that over $4 billion is spent annually on over-the-counter remedies for headache pain. If we add the monies spent on prescription drugs, the expense of lost workdays, fees for numerous visits to physicians’ offices and emergency departments, and repeated hospitalizations, the fiscal impact is staggering.

For the clinician treating the patient with headaches, it is essential to be aware of the various causes of this problem. The clinician should always be alert for the patient presenting with recent onset of headaches—a signal that a careful workup is needed to rule out organic, and possibly morbid, causes of the headache problem.

To effectively treat the patient with headache, an accurate diagnosis must be established. A headache history is important in evaluating the patient with headaches. A complete and thorough physical and neurologic examination will facilitate the diagnosis, and the clinician should be cognizant of the specific diagnostic tests used in headache workups. Finally, the clinician should be aware that adequate preventive therapy is available for patients and he/she is not limited to prescribing pain-relief measures.

Resources for the Clinician

The clinician treating patients with headache has two major resources in the United States. The National Headache Foundation (NHF) is the oldest and largest organization for headache patients, their families and friends, and their treating clinicians. The NHF serves as a resource center and supports education through public seminars held throughout the United States. To further research into the diagnosis and treatment of headache, the NHF provides grants for a variety of investigations. The physician members are listed in the professional membership directory and included on the state list of physician members. They receive professional and lay educational material, quarterly newsletters for distribution to their patients, professional discounts, and grant considerations.

Practitioners interested in the treatment of headache and the continuing research into this problem may be interested in joining a professional organization, The American Headache Society (AHS).