Primary headaches

Abstract

Headache syndromes are very common in pain practices. Despite the advocacy for diagnosis, treatment of headache disorders is still far from optimal (Kolodner et al., J Clin Epidemiol 57(9):962-72, 2004; Lipton et al., Headache 41(7):638-45, 2001; Lipton et al., Neurology 68(5):343-9, 2007). Headache can present as a single pain problem or can occur in the presence of other pain syndromes such as fibromyalgia, back pain, chronic abdominal pain, irritable bowel syndrome (IBS), and cervical radiculopathy (Kucuksen et al., Clin Rheumatol 32(7):983-90, 2013; Park et al., Gut Liver 7(6):668-74, 2013). According to American Headache Society estimates, there are about 36 million people with migraine in the USA. As with any other chronic pain condition, headaches are very expensive disorders and amount to about $29 billion per year in direct medical costs and indirect costs from lost productivity, absenteeism, and presenteeism. Furthermore, chronic headache disorders (Igarashi, Rinsho shinkeigaku, Clin Neurol 53(11):1225-7, 2013) and even the mere presence of headache (Arslantas et al., Turk Neurosurg 23(4):498-504, 2013) have both been shown to negatively affect the quality of life for patients. The clinical approach to diagnosis and management of headache disorders should involve a careful and exhaustive methodology and should be accompanied by understanding of relevant neuroanatomy, neurophysiology, and headache pharmacology.