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  • 1.HeadacheAnne MacGregorDirector of Clinical ResearchThe City of London Migraine ClinicAlison FrithClinical Research SisterThe City of London Migraine Clinic A John Wiley & Sons, Ltd., Publication

2. This edition rst published 2009, 2009 by Blackwell Publishing LtdBMJ Books is an imprint of BMJ Publishing Group Limited, used under licence by Blackwell Publishing which was acquired by JohnWiley & Sons in February 2007. Blackwells publishing programme has been merged with Wileys global Scientic, Technical andMedical business to form Wiley-Blackwell.Registered ofce:John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UKEditorial ofces:9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USAFor details of our global editorial ofces, for customer services and for information about how to apply for permission to reuse thecopyright material in this book please see our website at right of the author to be identied as the author of this work has been asserted in accordance with the Copyright, Designs andPatents Act 1988.All rights reserved. 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No warranty may be created or extended by any promotionalstatements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.Library of Congress Cataloging-in-Publication DataABC of headache / edited by Anne MacGregor, Alison Frith. p. ; cm.Includes bibliographical references and index.ISBN 978-1-4051-7066-6 (alk. paper)1. Headache. I. MacGregor, Anne, 1960 II. Frith, Alison.[DNLM: 1. Headachediagnosis. 2. Headache Disordersdiagnosis. WL 342 A112 2008]RC392.A27 2008616.8491dc222008001983ISBN: 978-1-4051-7066-6A catalogue record for this book is available from the British LibrarySet in 9.25/12 pt Minion by SNP Best-set Typesetter Ltd., Hong KongPrinted in Singapore by COS Printers Pte Ltd1 2009 3. Contents Preface, v Contributors, vi 1 Approach to Headaches, 1 Anne MacGregor 2 Migraine, 9 Anne MacGregor 3 Tension-type Headache, 15 Anne MacGregor 4 Cluster Headache, 20 David W. Dodick 5 Medication Overuse Headache, 24 David W. Dodick 6 Menstrual Headaches, 28 Alison Frith 7 Childhood Periodic Syndromes, 36 Ishaq Abu-Arafeh 8 Teenage Headache, 41 Ishaq Abu-Arafeh 9 Exertional Headache, 46 R. Allan Purdy10 Thunderclap Headache, 50 David W. Dodick11 Headache and Brain Tumour, 53 R. Allan Purdy12 Headache and Neck Pain, 56 Anne MacGregor13 Headache and Depression, 60 Anne MacGregor14 Pain in the Temple, 68 R. Allan Purdy15 Facial Pain, 72 David W. Dodick Further resources, 76 Index, 77iii 4. PrefaceOur aim with this ABC book is to provide the reader with a clear, included since they are greatly feared by both patients and health-concise text to recognize and manage headache effectively. We are care professionals.grateful for the opportunity to collaborate with colleagues to Individual case studies cannot address all the issues relating toprovide current information based on best available evidence anda specic group of headache sufferers. However, we felt it wasexpert specialist opinion.important to devote chapters on headache and associated syn- First we present an overall approach to headache including dromes in children and adolescents to highlight their speciceliciting the history, identifying red ags and current issues in issues. With regard to headache in the elderly, the treatments areinvestigation and management. The chapters that follow arethe same as for other age groups, but the differential diagnosis iscarefully selected case studies with emphasis on history taking toparticularly important as demonstrated in the chapter on giant cellestablish differential diagnoses, investigations that may be required arteritis. As a quarter of all women are affected by migraine andand specic management strategies. Although we illustrate the half of them recognise an association with menstruation, we felt itmain primary headaches of migraine, tension-type headache,was appropriate to include a case study for this group.and cluster headache, we recognize that not all secondaryWe hope that this approach to headache reects presentation ofheadache types are covered. Obvious headaches due to head headache to a wide range of healthcare professionals, helping themtrauma or infection for example, have been omitted. Instead, we to improve the diagnosis and the management of this complex andhave chosen common but under-recognized medication overusechallenging condition.headaches and headaches attributed to depression, neck painand trigeminal neuralgia. Headaches associated with underlyingAnne MacGregorcranial vascular disorder and brain tumours, although rare, are Alison Frithv 5. ContributorsIshaq Abu-Arafeh Anne MacGregorConsultant Paediatrician Director of Clinical ResearchStirling Royal InrmaryThe City of London Migraine ClinicStirling, UK London, UKDavid W. DodickR. Allan PurdyProfessor of Neurology Professor of Medicine (Neurology)Mayo Clinic ArizonaDalhousie UniversityScottsdale, Arizona, USHalifax, Nova Scotia, CanadaAlison FrithClinical Research SisterThe City of London Migraine ClinicLondon, UKvi 6. CHAPTER 1 Approach to Headaches Anne MacGregor OVERVI EW provide the most effective treatment. For most medical ailments the suspected diagnosis can be conrmed with tests, but no diag- Most headaches can be managed in primary care nostic test can conrm the most common headaches, such as The history is a crucial step in the correct diagnosismigraine or tension-type headache. This means that unless the Funduscopy is mandatory for anyone presenting with headache headache is obvious, diagnosis is largely based on the history. In Diary cards aid diagnosis and managementaddition, the examination of people with primary headaches is The presence of warning symptoms in the history and/oressentially normal. Consequently, the diagnosis is not always easy, physical signs on examination warrant investigation and may particularly if several headaches coexist, confusing both patient and indicate appropriate specialist referraldoctor. In a study of patients with a diagnosis of migraine who were referred to a specialist migraine clinic, nearly one third had a head- ache additional to migraine. Failure to recognize and manage the additional headache was the most common cause of treatmentIntroduction failure.Nearly everyone will experience headaches at some time in their It is not always possible to conrm the diagnosis at the rst visit.lives. Most headaches are trivial, with an obvious cause and minimal A structured history, followed by a relevant examination, can iden-associated disability. However, some headaches are sufciently tify patients who need immediate investigations or referral fromtroublesome that the person seeks medical help. Headache accountsthe non-urgent cases. Management and follow-up will depend onfor 4.4% of consultations in primary care (6.4% females and 2.5% whether the diagnosis is condently ascertained or is uncertainmales). Unless a correct diagnosis is made, it is not possible to(Figure 1.1). NOW MR JONES, JUST WHAT EXACTLY DO YOU THINK IS THE CAUSE OF YOUR HEADACHES?ABC of Headache. Edited by A. MacGregor & A. Frith. 2009 Blackwell Publishing, ISBN 978-1-4051-7066-6.1 7. 2 ABC of Headache 1st consultation HistoryE