According to the National Institute of Neurological Disorders and Stroke, headache is the most commonly experienced form of pain. Of more than 150 types of headache listed in the International Classification of Headache Disorders (ICHD), tension-type headache (60%-80%) and migraine (15%) have the highest prevalence. Although other types of headache are much less common, an accurate diagnosis is essential to inform treatment strategy, particularly with headache that may be secondary to a potentially life-threatening medical condition.

In a March 2019 review published in the Medical Clinics of North America, investigators summarized evidence on nonmigraine headache and facial pain.

Clinical Pain Advisor interviewed Nauman Tariq, MD, assistant professor of neurology at Johns Hopkins University School of Medicine and director of the Johns Hopkins Headache Center.

Clinical Pain Advisor: What are some key takeaways for clinicians regarding this topic?

Dr Tariq: Accurate diagnosis is very important because we do not have biomarkers to distinguish among the different types of headache, as in the way troponin is used in cardiac care, for example. There is some preliminary progress in the research, but those studies are very small. Thus, we have to rely on those set criteria, and many times, adequate experience and training are required to pick up the less common types of headache.

When the physician in an outpatient clinic is dealing with an unusual type of headache, I recommend that they visit the ICHD website, which features straightforward diagnostic criteria for the range of headache types. If a patient does not respond after a couple of treatment trials, then refer the person to a neurologist or headache specialist.

Often, patients can improve significantly with treatment, but if they have to wait 4 to 5 years to receive an accurate diagnosis, that is a lot of time living with unnecessary symptoms and disability, and their prognosis may worsen.


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