Headache and facial pain

Headache is one of the most common symptoms seen in both General Practice and Neurology clinics. The Physician's first duty is to exclude and treat any specific structural cause - especially subarachnoid haemorrhage and meningitis if the history is short, and temporal arteritis and cervical spondylosis if it is longer. It is unusual for a cerebral tumour to present with a headache for more than three months without physical signs being present. This review discusses all the common causes of acute, chronic, recurrent and progressive headache as seen in out-patient practice. The majority have migraine, a few have cluster headache and rarer trigemino-autonomic cephalalgias. Headaches are a major cause of distress and impaired productivity in the general population, and much can be reversed with appropriate medication given in adequate doses.