Headache

Abstract

Headache must be one of the commonest symptoms, and few specialties escape from the diagnostic problems that it may present. We must begin with the realisation that more or less everyone suffers from headache at some time or another. In fact, the majority of headaches that present have no detectable cause and are often labelled psychogenic if there seems to be a background of stress. The implication is that the sufferer is perhaps exaggerating mild symptoms in order to gain sympathy from his or her spouse, or even perhaps the doctor (Fig. 8.1). One must, of course, be extremely cautious about not accepting symptoms at their face value, and certainly cerebral tumours have been overlooked for this very reason. If the psychogenic headache is the commonest, then headache due to raised intracranial pressure and an intracranial space-occupying lesion must be the most important, and between these two a whole spectrum of causes must be considered. It is essential, therefore, to memorise a permanent check list in order that obvious causes are not omitted.