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Diagnosis of Migraine and Tension-Type Headaches

  • Stewart J. Tepper
  • Deborah E. Tepper
Chapter

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.

Keywords

Primary headaches Migraine Tension-type headaches Diagnosis Epidemiology Headache screeners Secondary headaches 

Suggested Reading

  1. Calhoun AH, Ford S, Millen C, Finkel AG, Truong Y, Nie Y. The prevalence of neck pain in migraine. Headache. 2010;50:1273–7.PubMedCrossRefGoogle Scholar
  2. Dodick DW. Clinical clues and clinical rules: primary versus secondary headache. Adv Stud Med. 2003;3:S550–5.Google Scholar
  3. Headache Classification Subcommittee of the International Headache Society. International classification of headache disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9–160.Google Scholar
  4. Lipton RB, Stewart WF, Cady R, et al. Sumatriptan for the range of headaches in migraine sufferers: results of the spectrum study. Headache. 2000;40:783–91.PubMedCrossRefGoogle Scholar
  5. Lipton RB, Dodick D, Sadovsky R, Kolodner K, Endicott J, Hettiarachchi J, et al. A self-administered screener for migraine in primary care: the ID migraine validation study. Neurology. 2003;61:375–82.PubMedGoogle Scholar
  6. Martin VT, Penzien DB, Houle TT, Andrew ME, Lofland KR. The predictive value of abbreviated migraine diagnostic criteria. Headache. 2005;45:1102–12.PubMedCrossRefGoogle Scholar
  7. Stewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, et al. An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology. 1999;22(53):988–94.Google Scholar
  8. Tepper SJ, Dahlof C, Dowson A, Newman L, Mansbach H, Jones M, et al. Prevalence and diagnosis of migraine in patients consulting their primary care physician with a complaint of headache: data from the landmark study. Headache. 2004;44:856–64.PubMedCrossRefGoogle Scholar
  9. Tepper SJ, Zatochill M, Szeto M, Sheftell FD, Tepper DE, Bigal ME. A simple menstrual migraine OB/GYN screener: the Menstrual Migraine Assessment Tool (MMAT). Headache. 2008;48:1419–25.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Center for Headache and PainNeurological Institute, Cleveland ClinicClevelandUSA
  2. 2.Center for Headache and PainNeurological Institute, Cleveland ClinicClevelandUSA

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