Introduction

Headache is a common affliction1 that can be highly disabling.2 There are two basic forms of headache - primary headaches, where the headache is the disease, such as migraine and tension-type headache, and secondary headaches, where another disease process produces headache as part of its pathophysiology, such as meningitis or the headache associated with brain tumors.3 Monographs are available covering the range of headache problems.4 Migraine is a particular, common, and disabling form of primary headache5 that has been well served by developments in serotonin pharmacology over the last 20 years.

Migraine is generally an episodic headache with certain associated features, such as sensitivity to light, sound, or movement, and often with nausea or vomiting accompanying the headache (Table 1). None of the features is compulsory,3 and indeed given that the migraine aura, visual disturbances with flashing lights, or zigzag lines moving across the fields or other neurological symptoms are reported in only about 30% of patients,6 a high index of suspicion is required to diagnose migraine. A headache diary can often be helpful in making the diagnosis,7 in assessing disability, or recording how often patients use acute attack treatments. It is relevant to mention in the context of preventive treatments that migraine can be daily, as a subset of the broad group of problems known as chronic daily headache.8 In differentiating the two main primary headache syndromes seen in clinical practice, migraine at its most simple level is headache with associated features, and tension-type headache is headache that is featureless, i.e., headache alone.

Table 1 Simplified diagnostic criteria for migraine

Repeated attacks of headache lasting 4-72 h that have these features, normal physical examination, and no other reasonable cause for the headache: At least two of: At least one of:

* Unilateral pain * Nausea/vomiting

* Throbbing pain * Photophobia and phonophobia

* Aggravation by movement

* Moderate or severe intensity

Adapted from the International Headache Society Classification.86

Stop Headache Drug Free

Stop Headache Drug Free

If you are suffering from headaches, you can make the pain stop just by following some basic but little known principles. Take 15 minutes browsing through this guide and you'll find dozens of tips to gain control in the battle against headache pain.

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