5% of North American and Western European populations have headache on at least 15 days a month for, on average, four or more hours a day
a chronic daily headache is not just tension-type headache, nor is it all just due to medication overuse
if a doctor gets a history of frequent headache they need to pursue its basis
clinician needs to be aware of features suggestive of sinister or secondary headache. These include (1):
pain of sudden onset
fever
marked change in pain character or timing
neck stiffness
pain associated with higher centre complaints
pain associated with neurological disturbance e.g. clumsiness or weakness
pain associated with local tenderness, such as of the temporal artery
if a positive diagnosis that the headache is benign cannot be made then patients with a headache that is of recent onset or with neurological signs require brain imaging with computed tomography or magnetic resonance imaging (1)
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