Diagnosis of Migraine and Tension-Type Headaches

Abstract

Headache diagnosis in the office is predicated on deciding if the patient’s headache is primary or secondary. Aiding diagnosis is the use of the International Classification of Headache Disorders, second edition (ICHD-2), as well as abbreviated screeners. While migraine is the most common primary headache seen in the office, tension-­type headache is more common in the community. The authors discuss the diagnostic findings typically seen with migraine and tension-type headaches, then review the red flags that can point to a more sinister etiology meriting further workup. Using Dr. David Dodick’s SNOOP mnemonic for secondary workup can help avoid the dangerous pitfalls of missing a secondary headache. Correct diagnosis often starts with pattern recognition when a patient presents to the clinician’s office, and this can be helped by using brief migraine screeners. Utilizing scales for impact and disability helps in both diagnosis as well as in targeting appropriate intervention in treating headaches.