Headache: differentiating among the types, use of imaging, and medication overuse headache.

Gary A. L’Europa MD, FASH  wHat CliniCal findings are Most useful for differentiating aMong tHe various types of HeadaCHes? When asked to comment on this topic I immediately thought of the advice that Seymour Diamond, founder of the Diamond Headache Center and the godfather of headache gave to his daughter Merl when she succeeded him as director, “Merl, it’s all migraine.” About 90% of all the patients that we see at The Headache Center are diagnosed with probable Medication Overuse Headache (Analgesic Rebound) on their first visit. Once they are successfully treated, their underlying headache disorder is usually migraine or a combination of migraine and tension type headache. In a primary care setting, the vast majority of patients you will see with headache have migraine. As in all of medicine the history remains the key to diagnosis, however with primary headaches the history is the only means for diagnosis. There were no accepted ways to diagnose migraine until 1988 when The International Headache Society developed a classification of headache with criteria to diagnose each headache. There are 14 categories that are divided into 3 groups: Primary, Secondary and Cranial Neuralgias. Primary headaches are those that exist independent from any other medical condition. Secondary headaches are those caused by another medical disorder. Even the members of the classification committee cannot remember all the criteria however in clinical practice it is helpful to know the criteria for migraine. The diagnostic criteria for migraine are as follows: