Diagnostic screen for assessment of the IHS criteria for migraine by general practitioners. A self-administered screener for migraine in primary care: the ID Migraine validation study. Does this patient with headache have a migraine or need neuroimaging?. Direct and indirect healthcare resource utilization and costs among migraine patients in the United States. Usefulness of the SF-8 health survey for comparing the impact of migraine and other conditions. Turner-Bowker DM, Bayliss MS, Ware JE, et al. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Migraine prevalence, disease burden, and the need for preventive therapy. Epidemiology of headache in a general population-a prevalence study. Rasmussen BK, Jensen R, Schroll M, et al. Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Lyngberg AC, Rasmussen BK, Jørgensen T, et al. Diagnosis and management of headache: a review. The epidemiology of primary headache disorders. The international classification of headache disorders, 3rd edition. Headache Classification Committee of the International Headache Society. Beithon J, Gallenberg M, Johnson K, et al. Institute for Clinical Systems Improvement. Guideline for primary care management of headache in adults. Primary headache disorders without red flags or abnormal examination findings do not need neuroimaging.īecker WJ, Findlay T, Moga C, et al. For less urgent cases, magnetic resonance imaging of the brain is preferred for evaluating headaches with concerning features. A lumbar puncture is also needed to rule out subarachnoid hemorrhage if the scan result is normal. For emergent evaluations, noncontrast computed tomography of the head is recommended to exclude acute intracranial hemorrhage or mass effect. Red flag signs or symptoms such as acute thunderclap headache, fever, meningeal irritation on physical examination, papilledema with focal neurologic signs, impaired consciousness, and concern for acute glaucoma warrant immediate evaluation. Evaluating acute headaches using a systematic framework such as the SNNOOP10 mnemonic can help detect life-threatening secondary causes of headaches. Signs such as predictable timing, sensitivity to smells or sounds, family history of migraine, recurrent sinus headache, or recurrent severe headaches with a normal neurologic examination could indicate migraine headache. Among primary headache disorders, tension-type headache is the most common, although a migraine headache is more debilitating and likely to present in the primary care setting. Most headaches that are diagnosed in the primary care setting are benign. A detailed history and physical examination can distinguish between key features of a benign primary headache and concerning symptoms that warrant further evaluation for a secondary headache.
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