There are many types and reasons for headache, some with serious consequences if not diagnosed and treated appropriately. Since more than 15% of the US adults suffer from migraines, and more than 90% of patients with recurrent headaches who seek help from primary care physicians and the emergency department are ultimately diagnosed with migraine, we will focus on migraines for this discussion. Studies suggest that migraine headaches can be inherited with a 40% risk if one parent had migraines and a 75% risk if both parents had migraines. After adolescence, migraine headaches are more common in women with the highest prevalence in the fifth decade of life. The classic description of a migraine is a unilateral, throbbing headache that is accompanied by a sensitivity to light, sound or nausea and may be disabling. As many as 30% of patients with migraine headaches will have an “aura” or a combination of visual, hemisensory or language abnormalities that develop abruptly and can last for up to an hour. In many cases the diagnosis is made based on the history however a thorough physical exam can exclude alternatives and support the diagnosis. It is usually unnecessary to perform an imaging studies. Treatment depends on the severity and frequency of the headaches. For some patients, over the counter medications as needed may be adequate where as for other patients prescription prophylactic medications may be required.
MacGregor EA. In The Clinic: Migraine. Ann Intern Med. 2017. Apr 4; 166 (7)