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Clinical investigations from the RACP

Investigation of patients presenting with headache

Miriam Wronski, Alessandro S Zagami

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Abstract

Headache has many potential causes, most of which are benign. A systematic approach, including taking a careful history and performing a physical examination to screen for red flag features, will identify patients requiring neuroimaging.

Key Points

  • Headache in the primary care setting most often has a benign cause, usually a primary headache disorder.
  • The type of most headaches can be determined by taking a detailed history and performing a targeted examination, without the need for special investigations.
  • Neuroimaging is not required for people with normal neurological examination results and no warning features (‘red flags’).
  • General practitioners can now request Medicare-reimbursed MRIs of the brain to investigate chronic headache with suspected underlying intracranial pathology.
  • Neuroimaging may identify incidental unrelated neurological abnormalities that can heighten patient anxiety and lead to practical and ethical dilemmas regarding management.

    Picture credit: © Sciepro/Getty Images.

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