Introduction
A headache of some type occurs in approximately 90% of the population each
year. It is most unusual to encounter a person who denies having a headache of
some type during their entire life. Headache is the presenting complaint of 2– 4
% of patients seeking care in emergency room or in the office of a primary care
physician. When including the indirect cost of time lost from not being fully
productive at work, travel for unnecessary imaging studies, emergency room
visits, etc, migraine is estimated to be a thirty billion dollar illness in the USA.
With proper medical care most patients with headache can be helped.
Most treatments for the primary headache disorders are not “evidence based” but
have been learned from past clinical experience. For example there has never
been a double blind study proving that aspirin or acetaminophen improve a
simple tension-type headache.
The following a is a series of short reviews of various aspects of headache
designed to compliment the lectures and clinical teaching that medical students
and residents might have had in the past. Like information that is spoken during
a lecture, there will be no references to printed material. Further information can
be obtained by searching the internet. If necessary these short notes will be
updated from time to time as new information develops.
John S. Warner, M.D.
Professor, Emeritus
Department of Neurology
Vanderbilt University School of Medicine
Nashville, Tennessee