Clinical investigations from the RACP

Investigation of headache

Richard Stark

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Abstract

Most patients presenting with recurrent or chronic headache will have one of the three primary headache disorders, therefore investigations are unlikely to be abnormal. It is important, however, to exclude serious neurological disease.

Key Points

  • Most patients presenting with chronic or recurrent headache will have one of the primary headache disorders; therefore, investigations are unlikely to be abnormal.
  • A sound understanding of the usual presentation of the common primary headaches is vital. Often, these headaches can be diagnosed without the need for special tests.
  • Headaches occurring with new, abrupt onset or with relentless progression are likely to be caused by specific pathology and appropriate investigation must be carried out.
  • In most cases in which brain imaging is required, MRI is preferable to CT, which may lead to practical difficulties for GPs.
  • The mnemonic ‘SNOOP-4’ is a useful checklist of ‘red flag’ conditions in patients presenting with headache.

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