Approach to headache patient

Yi-Chia Liaw MD

Headache & Pain

Updated 08.07.2025
Released 01.17.2021
Expires For CME 08.07.2028

Approach to headache patient

Author: Yi-Chia Liaw MD

See Contributor Disclosures

Editor: Shuu-Jiun Wang MD

Cite this article

Approach to headache patient

In This Article

Quick Link

Introduction

Overview

Headache is a medical problem commonly encountered by neurologists and primary care practitioners globally. It causes substantial pain and disability and is associated with a high burden and considerable costs. Headache is listed among the World Health Organization’s major causes of disability, with a global prevalence of 52%, and women have a higher prevalence than men (45). Because the affected population are mainly among the working ages, headache adds socioeconomic burden with loss of productivity.

Key points

	• Headache is one of the most common medical problems observed by neurologists and a major cause of disability in young people.
	• Diagnosis of headache is based on well-defined clinical criteria according to the International Headache Society.
	• Approach to headache patient includes pharmacological treatment and recommendations about lifestyle adjustments.
	• Headache assessment includes not only headache-related parameters but also patients’ quality of life assessment (through patient-reported outcomes).
	• New and specific acute and preventive treatments are now available, including CGRP-targeted monoclonal antibodies, gepants, and ditans.

Approach

A detailed assessment and structured interview are the cornerstones to approaching a headache patient. This leads to an accurate clinical assessment in order to make a correct diagnosis and consequently to start the most appropriate treatment, to establish an acute and preventive medical treatment according to the individual’s characteristics, and to provide headache education in order to empower patients and promote healthcare patient based.

Approach to headache patients in a neurologic outpatient clinic

A structured and patient-centered interview is a cornerstone to start the approach to headache patients. These include not only headache-related information but also non-headache-related data. After performing a focused physica...

With the aim of improving clinical decision-making, primary care practitioners, neurologists, and headache specialists published a consensus statement in 2021 (19). The authors thoroughly state 10 practical steps divided in three parts: diagnosis, acute and preventive treatment, and clinical management and follow-up. Moreover, the importance of a structured approach and polished communication skills during evaluation are emphasized in a review article published in 2024 (20).

Diagnosis

In clinical practice, around 15.1% of headache patients come from referrals, and among them, 84% come from private offices or clinics of other specialties (22). Therefore, it is mandatory that healthcare professionals be aware of common headache disorders. Timely management can lead to improvement in a patient’s quality of life. To achieve this goal, gathering an adequately useful clinical history and a sophisticated and targeted physical examination are both essential to get a reliable diagnosis and, consequently, to establish the most appropriate medical treatment.

Clinical history. Diagnosis in headache disorders is currently based on well-defined criteria established by the International Headache Society (27). Therefore, it is essential to know about the most common sections, mainly migraine. Physicians should suspect the differential diagnosis of migraine if a patient has recurrent headache for at least five times, with moderate to severe intensity, a unilateral presentation, pulsatile sensation in quality, a worsening of headache during physical activity, and the accompanied nausea/ vomiting sensation or photophobia and phonophobia. From time to time, an aura, commonly presenting as a transient reversible neurologic deficit, can be identified before or during the headache attack. A family history of migraine or an onset of symptoms around puberty could enhance diagnostic confidence (19). However, it is important to watch for red flags to discard secondary or life-threatening headaches. The simple mnemonic “SNOOPs” covers the common scenario of secondary headaches: headache co-occurs with Systemic signs (ie, fever, body weight loss, etc.), Neurologic deficits, an acute Onset pattern, a first headache Onset in an elderly patient, and with Pattern change, Postural component, Papilledema, or Precipitated by exertion (16).

Physical examination. The physical examination should be systematic and holistic and should not be excluded when a patient with headache is first encountered in the office. Commonly, this includes neurologic examinations over the craniofacial area and general examinations (21). General examination tends to detect signs of a secondary headache. For example, a string of blisters observed over the cranial regions provides a clue to the diagnosis of zoster infection. In another condition, a focal neurologic sign, such as unilateral weakness, may raise suspicions of intracranial lesions. Other detailed options include fundoscopic exam to assess for papilledema or pinpricking to assess for allodynia. Furthermore, passive neck movements may help identify neck stiffness caused by subarachnoid hemorrhage.

Comorbidities. It is essential to assess comorbidities because they have an important impact on the treatment. Suffering from concurrent disorders, especially psychiatric disorders like depression or panic disorder, would also make the treatment more complicated. Regarding migraine, these comorbidities may also be involved in the transformation from episodic to chronic migraine, making the management more challenging (39; 36; 07; 40).

Questionnaires. Structured questionnaires can help to determine the degree of disability at baseline and to evaluate the response to treatments. Commonly used questionnaires used to evaluate severity include the Headache Impact Test (HIT-6) and the Migraine Disability Assessment Test (MIDAS). The Hospital Anxiety and Depression Scale (HADS) help to assess emotional and psychiatric comorbidity. This is particularly important in these patients and may influence the decision on preventative therapy because many of these can exacerbate depression and anxiety.

Headache diaries. Using a headache diary helps quantify the headache and provides a contemporary record of pain. Using a diary can reduce the potential recall bias and offers an opportunity to identify potential trigger factors. Moreover, it improves the doctor-patient relationship, and it facilitates decision making. The diaries also assist in monitoring the treatment response, identifying triggers, the relationship to menses, and the frequency of analgesic use.

Of note, imbursement of novel medications by national insurance in some countries and regions also relies on a detailed diary record, and, therefore, the benefit is multifaceted. Still, it is important to emphasize patient centricity and education when performing this strategy. Physicians must provide appropriate reassurance, agree on realistic objectives, identify predisposing and/or trigger factors, and follow a strategy to individualize therapy based on the diary record (19).

Artificial intelligence. The development of artificial intelligence has rocketed in the medical field. One of the strengths of artificial intelligence in diagnosing headache is the development of natural language processing and machine learning, which enhance the accuracy of the diagnostic rate, thereby providing a more convenient diagnostic tool for non-headache specialists or even primary care providers. Current evidence shows that the accuracy of artificial intelligence could help in the diagnosis of migraine or probable migraine. However, because most models were not well validated, physicians should be more aware of interpretation of the data (11; 42; 46).

Therapeutic management

Clinical and scientific evidence supports that proper management of patients with headache should be multimodal including appropriate use of pharmacological and nonpharmacological interventions. Regarding migraine, its treatment is increasingly focused on a personalized approach, ie, the right drug to the right patient at the right dose at the right time.

Nonpharmacological treatments. It is important to acknowledge the convenience of nonpharmacological treatment because these therapies are frequently requested by individuals with headache, particularly in specific situations, such as childhood, pregnancy, and breastfeeding. Nowadays, it is also important to know that there is a wide range of alternative therapies, but they have variable and scarce scientific evidence.

Some evidence supports the use of noninvasive neuromodulatory devices (43), biobehavioral therapy (47), and acupuncture (25), although a study of acupuncture indicated that it is not superior to sham acupuncture (15). Contrary to popular belief, little to no evidence exists for physical therapy, spinal manipulation, and dietary approaches (34). Other therapeutic options, such as melatonin, magnesium, and riboflavin, have limited evidence for their efficacy, and their use in clinical practice is limited (29).

Pharmacological treatment. Due to its high prevalence and socioeconomic burden, the following sections focus on the pharmacological treatment of migraine. Individualized approaches using a combination of novel agents with oral prophylactic drugs or botulinum toxin A, switching between new drugs, and adjusting treatment duration could enhance excellence in practice.

Acute treatment. Acute migraine treatments can be generally categorized into two main categories: (1) migraine-specific agents and (2) nonspecific agents.

Among migraine-specific agents, triptans are a commonly used drug category. There are seven triptans that work mainly as a serotonin 5HT-1B receptor agonist. We advise patients to use a triptan at the start of the headache phase because there is no efficacy evidence if taken during preceding aura. The route of administration should be best tailored to the individual’s migraine attack. For example, for a patient presenting with severe vomiting during headache attack, a nasal spray could be a better option. Moreover, the effect of a triptan depends on its route of administration. Thus, subcutaneous sumatriptan is the fastest one, followed by nasal preparations. In general, most adverse effects of triptans are well tolerated. However, there are cardiovascular safety concerns associated with triptan use due to the presence of 5HT-1B receptors on vascular smooth muscle. Therefore, triptans are generally avoided in people with uncontrolled hypertension and with a history of cardiovascular or cerebrovascular diseases.

If all available triptans fail after an adequate trial period (no or insufficient therapeutic response in at least three consecutive attacks), or their use is contraindicated due to potential cardiovascular risk, a similar category of drug, ditans, could be considered. Ditans exert their effect on a different subtype of serotonin receptor (5-HT1F) and, therefore, limit the extent of vasoconstriction. Currently, lasmiditan is the only ditan approved for acute treatment.

Ubrogepant, atogepant, and rimegepant are the gepants approved for the acute treatment of migraine (23; 33; 32). These medications are small molecules that act as calcitonin gene-related peptide (CGRP) receptor antagonists (02). The gepants and ditans likely offer a comparable alternative to triptans for patients with cardiovascular risk factors (23), and it seems that they do not lead to medication overuse headache. Furthermore, post-hoc analyses reported no differences in efficacy of gepants/ditans between responders and nonresponders to triptans (12).

Dihydroergotamine, an ergots derivative, was previously used as a treatment for migraine. This medication has shown a similar adverse effect with triptans. As for the combination of pills, including ergotamine and caffeine, treatment efficacy is not as high as dihydroergotamine (35).

Besides these migraine-specific treatments, nonspecific agents, such as acetaminophen, nonsteroid anti-inflammatory drugs (NSAIDs), and drug combinations (acetaminophen-aspirin-caffeine), could be tried. Most of these are over-the-counter medications and are commonly used as a first-line acute treatment option.

An antiemetic could be used, even if nausea is not pronounced, to counter gastric stasis and facilitate tablet absorption and pain relief. Among them, prochlorperazine and metoclopramide were more commonly used parenterally.

It is important to note that acute treatment should be limited, on average, to no more than 10 days per month for migraine-specific medications and on no more than 15 days per month for nonspecific medications like NSAIDs or acetaminophen, to reduce the risk of medication overuse.

Another alternative treatment option is nerve blocks. Occipital nerve block, consisting of a local anesthetic and/or corticosteroid, has shown to be an effective treatment for the management of migraines. Occipital nerve block has been reported to reduce migraine pain scores, frequency, and duration (18). Nerve blocks with lidocaine is a suitable option for migraine treatment during pregnancy if it is needed.

Management on medication-overuse headache. Medication-overuse headache is a secondary headache occurring on 10 to 15 or more days per month, developing as a consequence of regular overuse of acute headache medication (simple analgesics and NSAIDs on 15 days or more; or triptans, opioids, and combination analgesics on 10 days or more days per month) for over three months.

Treatment of medication-overuse headache has three components. First, patients need education and counseling to reduce the intake of medication for acute headache attacks. Second, some patients benefit from drug withdrawal (discontinuation of the overused medication). The overused abortive medication should ideally be stopped for at least one month. Finally, preventive drug therapy and nonmedical prevention might be necessary in patients at onset of treatment or in patients who do not respond to the first two steps. The optimal therapeutic approach requires validation in controlled trials (14). Nowadays, there is a lot of controversy as to whether migraine preventatives should be started while there is still ongoing medication overuse.

Preventative treatment. Migraine preventative treatments aim to reduce the frequency and severity of attacks and may help reduce the frequency of analgesic use. It is important to manage patient’s expectations before starting treatment. Prophylactic treatment is recommended for patients adversely affected on greater than or equal to two days per month despite optimized acute therapy (19).

In addition, the choice of a certain preventative treatment is influenced by the guideline’s recommendations for each country, considering type of migraine, patient’s characteristics, and comorbidities.

Oral prophylactics. The agents used can be classified into antiepileptic drugs, beta blockers, antidepressants, calcium channel antagonists, and angiotensin modulators (ACE inhibitors and angiotensin-receptor inhibitors). The general rules of thumb are to start treatment at a low dose, gradually increasing to an initial target dose. If there is no effect and no significant side effects, the dose can be further increased for some drugs. We continue the medication for at least three months to evaluate efficacy. If effective (about a 50% improvement) the drug may be continued for 6 months, although there is some evidence of fewer rebound headaches if continued for 12 months.

OnabotulinumtoxinA. In 2010, OnabotulinumtoxinA was reported effective for the treatment of chronic migraine in the Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials (04; 13) and was approved both by the European Medicines Agency and by the U.S. Food and Drug Administration for the prophylaxis of chronic migraine. OnabotulinumtoxinA has not been found effective in episodic migraine or in tension-type headache. There are European and American guidelines on the use of onabotulinumtoxinA in chronic migraine (44; 05).

CGRP pathway targeted treatments. The CGRP mAbs are the first class of preventive medication to specifically target the pathophysiology of migraine. Their efficacy, tolerability, and lack of drug-drug interactions make them ideal for many patients who have been unsuccessfully treated with other preventives (10). Currently, there are four CGRP-mABs placed on the market. Financing conditions are different for each country. One of the approved drugs targets the CGRP receptor (erenumab), whereas three target the CGRP ligand (fremanezumab, galcanezumab, and eptinezumab). Erenumab, galcanezumab and fremanezumab are given by subcutaneous injection monthly, although fremanezumab can also be given quarterly. Eptinezumab is given by intravenous infusion quarterly. They have been found to be effective in episodic and chronic migraine (01).

Another class of CGRP pathway treatment for headache prevention is gepants. Currently, atogepant and rimegepant are both included in this category. These medications have advantages in oral dosing.

Outcomes. Although measuring disability is a key step toward managing it, stratified care-based treatment guidelines, which match the severity of disability to the intensity of therapeutic interventions, may be needed to close the loop between process measures and functional outcomes.

Education in headache

Lifestyle adjustments. Irrespective of treatment modalities applied, trigger avoidance and lifestyle modification are indispensable to the successful management of migraine (37). This is especially important in children, adolescents, or pregnant women where drug treatments must be especially limited.

Although there is no robust evidence for most of the recommendations, most are general health measures that, given the lack of adverse effects and the benefit for general well-being, we consider should be recommended in all patients.

Avoid triggers. Many patients attribute the onset or worsening of pain to specific triggers such as stress, sleep changes, food, or atmospheric changes, among others. It is even possible that the relationship occurs inversely, so that premonitory symptoms, such as sleep disturbances and appetite change 48 to 72 hours before the onset of pain, can be misinterpreted by the patient as the trigger of migraine attacks. The therapeutic implications of this relationship are also unclear. There are possible triggers such as sleep deprivation, fasting, or certain foods that can be easily avoided. However, avoiding a certain potential trigger can lead to very restrictive lifestyles with a reduction in quality of life that does not outweigh the potential benefits (28).

Sleep. Another complex relationship is headache and sleep. An excess or lack of sleep can trigger migraine attacks and at the same time rest is one of the most used treatments to improve the symptoms of the migraine attack. Additionally, migraine and other headaches occur comorbidly with sleep disorders. Patients with chronic migraine have a higher prevalence of sleep disorders, specifically poor sleep habits and nonrestorative rest (48).

Regarding general sleep measures for patients with headache, it is recommended to define regular sleep schedules that allow 8 hours of rest per day, insisting that they remain constant also during the weekend; have dinner 4 hours before bedtime and avoid liquids in the last 2 hours; and eliminate naps and avoid using screens, television, reading, or listening to music in bed. A nonpharmacological intervention to improve sleep habits can improve headache frequency and even reverse chronic to episodic migraine (08).

Diet. In the scientific literature, multiple and varied diets are proposed that aim to reduce the frequency of headaches. There are two main approaches: elimination diets, which consist of suppressing potentially triggering foods such as chocolate, alcohol, cheese, nuts, or citrus fruits and diets that provide high or low amounts of certain components, ie, rich in vitamin B12, B6, or D or low in histamine, lactose, or fatty acids. The studies are not very rigorous, and most do not have a control group (38). In addition, it must be considered that food triggers were only associated with onset of headache in less than 10% of the participants (41).

Dietary recommendations for patients with migraine should be the same as for the general population with special emphasis on the prevention of obesity, which is a factor related to headache chronification. It is recommendable to have a varied diet, eating five meals a day to avoid periods of prolonged fasting and incorporating water intake to reach around 2.5 liters per day, which should be increased in case of physical activity or increase in temperature or humidity. Specific diets should be recommended solely based on whether there are other comorbidities in the patient (41).

Caffeine at moderate doses (< 400mg/day: equivalent to two cups of coffee) does not seem to have a negative effect on headache frequency although it should be taken regularly to avoid withdrawal headaches (38).

Although patients with migraine headaches and cluster headaches may be more susceptible to alcohol as a precipitant, there is no evidence to recommend abstinence from alcohol in all patients. Individual predisposition and cultural factors must be considered (17).

Exercise. Aerobic exercise can prevent or reduce symptoms of multiple chronic diseases, including headache. With some methodological limitations, there are studies that demonstrate benefits of aerobic exercise as a therapeutic intervention to reduce the frequency and intensity of headaches, as well as the quality of life measured by questionnaires. Exercise can have a beneficial effect on headaches directly but also indirectly, improving sleep quality, mood, cardiovascular function, and preventing weight gain. In addition, it can improve the control of other diseases frequently comorbid with headache, such as obesity, hypertension, anxiety, depression, or sleep disorders (30). The clinical benefit of yoga as an add-on therapy in patients with episodic migraine has been demonstrated (31).

Obesity. A higher body mass index is associated with greater frequency, intensity, and disability of migraine. Also keep in mind that preventive treatments for migraine (except topiramate) can potentially cause weight gain. Therefore, weight loss could improve the impact of the headache.

In patients with migraine headaches and overweight, education to avoid weight gain including dietary measures and frequent exercise should be added to their nonpharmacological treatment plan (09).

References

01: Alasad YW, Asha MZ. Monoclonal antibodies as a preventive therapy for migraine: A meta-analysis. Clin Neurol Neurosurg [Internet] 2020;195:105900. PMID 32460120
02: Aoh Y, Hou TW, Yang CC, et al. Update on gepants for the treatment of chronic migraine. J Chin Med Assoc 2024;87(4):350-6. PMID 38349136
03: Ashina M, Buse DC, Ashina H, et al. Migraine: integrated approaches to clinical management and emerging treatments. Lancet 2021;397(10283):1505-18. PMID 33773612
04: Aurora S, Dodick D, Turkel C, et al. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo- controlled phase of the PREEMPT 1 trial. Cephalalgia 2010;30(7):793-803. PMID 20647170
05: Bendtsen L, Sacco S, Ashina M, et al. Guideline on the use of onabotulinumtoxinA in chronic migraine: a consensus statement from the European Headache Federation. J Headache Pain 2018;19(1):91. PMID 30259200
06: Burch R. Epidemiology and treatment of menstrual migraine and migraine during pregnancy and lactation: a narrative review. Headache 2020;60(1):200-16.** PMID 31579938
07: Burch RC, Buse DC, Lipton RB. Migraine: epidemiology, burden, and comorbidity. Neurol Clin 2019;37(4):631-49. PMID 31563224
08: Calhoun AH, Ford S. Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache 2007;47(8):1178-83. PMID 17883522
09: Cervoni C, Bond DS, Seng EK. Behavioral weight loss treatments for individuals with migraine and obesity. Curr Pain Headache Rep 2016;20(2):13. PMID 26862055
10: Charles A, Pozo-Rosich P. Targeting calcitonin gene-related peptide: a new era in migraine therapy. Lancet 2019;394(10210):1765-74.** PMID 31668411
11: Cowan RP, Rapoport AM, Blythe J, et al. Diagnostic accuracy of an artificial intelligence online engine in migraine: a multi-center study. Headache 2022;62(7):870-82. PMID 35657603
12: de Boer I, Verhagen IE, Souza MNP, Ashina M. Place of next generation acute migraine specific treatments among triptans, non-responders and contraindications to triptans and possible combination therapies. Cephalalgia 2023;43(2):3331024221143773. PMID 36739516
13: Diener HC, Dodick DW, Aurora SK, et al. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 2010;30(7):804-14. PMID 20647171
14: Diener HC, Dodick D, Evers S, et al. Pathophysiology, prevention, and treatment of medication overuse headache. Lancet Neurol 2019;18(9):891-902.** PMID 31174999
15: Diener HC, Kronfeld K, Boewing G, et al. Efficacy of acupuncture for the prophylaxis of migraine: A multicentre randomised controlled clinical trial. Lancet Neurol 2006;5(4):310-6. PMID 16545747
16: Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology 2019;92(3):134-44. PMID 30587518
17: Dueland AN. Headache and alcohol. Headache 2015;55(7):1045-9. PMID 26121267
18: Ebied AM, Nguyen DT, Dang T. Evaluation of occipital nerve blocks for acute pain relief of migraines. J Clin Pharmacol 2020;60(3):378-83. PMID 31595507
19: Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021;17(8):501-14. PMID 34145431
20: Friedman DI. Approach to the patient with headache. Continuum (Minneap Minn) 2024;30(2):296-324.** PMID 38568485
21: Gago-Veiga AB, Camiña Muñiz J, García-Azorín D, et al. Headache: what to ask, how to examine, and what scales to use. recommendations of the Spanish Society of Neurology’s Headache Study Group. Neurologia 2019;S0213-4853(19)30024-6. PMID 30929913
22: Genc H, Uluduz D, Bolay H, et al. Evaluating headache referral trends and practices across different settings in neurology clinics: insights from an international cross-sectional multicenter study. J Oral Facial Pain Headache 2025;39(1):187-95. PMID 40129437
23: Goadsby PJ. Primary headache disorders: five new things. Neurol Clin Pract 2019;9(3):233-40. PMID 31341711
24: Goadsby PJ, Wietecha LA, Dennehy EB, et al. Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine. Brain 2019;142(7):1894-904. PMID 31132795
25: Govind N. Acupuncture for the prevention of episodic migraine. Res Nurs Health 2019;42(1):87-8. PMID 30730045
26: Greene K, Irwin SL, Gelfand AA. Pediatric migraine: an update. Neurol Clin 2019;37(4):815-33. PMID 31563234
27: Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38(1):1-211.** PMID 29368949
28: Hoffmann J, Recober A. Migraine and triggers: post hoc ergo propter hoc? Curr Pain Headache Rep 2013;17(10):370. PMID 23996725
29: Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The role of diet and nutrition in migraine triggers and treatment: a systematic literature review. Headache 2020;60(7):1300-16. PMID 32449944
30: Irby MB, Bond DS, Lipton RB, Nicklas B, Houle TT, Penzien DB. Aerobic exercise for reducing migraine burden: mechanisms, markers, and models of change processes. Headache 2016;56(2):357-69. PMID 26643584
31: Kumar A, Bhatia R, Sharma G, et al. Effect of yoga as add-on therapy in migraine (CONTAIN): a randomized clinical trial. Neurology 2020;94(21):e2203-12. PMID 32376640
32: Lipton RB, Croop R, Stock EG, et al. Rimegepant, an oral calcitonin gene-related peptide receptor antagonist, for migraine. N Engl J Med 2019b;381(2):142-9. PMID 31291516
33: Lipton RB, Dodick DW, Ailani J, et al. Effect of ubrogepant vs placebo on pain and the most bothersome associated symptom in the acute treatment of migraine: The achieve ii randomized clinical trial. JAMA 2019a;322(19):1887-98. PMID 31742631
34: Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine - systematic review and meta-analysis. Cephalalgia 2016;36(5):474-92. PMID 26229071
35: Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache 2015;55(1):3-20. PMID 25600718
36: Martami F, Ghorbani Z, Abolhasani M, et al. Comorbidity of gastrointestinal disorders, migraine, and tension-type headache: a cross-sectional study in Iran. Neurol Sci 2018;39(1):63-70. PMID 29022143
37: Martin PR. Behavioral management of migraine headache triggers: learning to cope with triggers. Curr Pain Headache Rep 2010;14(3):221-7. PMID 20425190
38: Martin VT, Brinder V. Diet and headache: part 1. Headache 2016;56(9):1543-52. PMID 27699780
39: May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol 2016;12(8):455-64.** PMID 27389092
40: McCracken HT, Thaxter LY, Smitherman TA. Psychiatric comorbidities of migraine. Handb Clin Neurol 2024;199:505-16. PMID 38307666
41: Peris F, Donoghue S, Torres F, Mian AW, Wober C. Towards improved migraine management: determining potential trigger factors in individual patients. Cephalalgia 2017;37(5):452-63. PMID 27179352
42: Petrusic I, Ha WS, Labastida-Ramirez A, et al. Influence of next-generation artificial intelligence on headache research, diagnosis and treatment: the junior editorial board members' vision - part 1. J Headache Pain 2024;25(1):151. PMID 39272003
43: Reuter U, McClure C, Liebler E, Pozo-Rosich P. Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials. J Neurol Neurosurg Psychiatry 2019;90(7):796-804. PMID 30824632
44: Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2016;86(19):1818-26. PMID 27164716
45: Stovner LJ, Hagen K, Linde M, et al. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain 2022;23(1):34 (2022). PMID 35410119
46: Stubberud A, Langseth H, Nachev P, Matharu MS, Tronvik E. Artificial intelligence and headache. Cephalalgia 2024;44(8):3331024241268290. PMID 39099427
47: Sullivan A, Cousins S, Ridsdale L. Psychological interventions for migraine: a systematic review. J Neurol 2016;263(12):2369-77. PMID 27159991
48: Torres-Ferrus M, Quintana M, Fernandez-Morales J, Alvarez-Sabin J, Pozo-Rosich P. When does chronic migraine strike? A clinical comparison of migraine according to the headache days suffered per month. Cephalalgia 2017;37(2):104-13.** PMID 26961321
49: References especially recommended by the author or editor for general reading.

Contributors

All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.

Author

Yi-Chia Liaw MD

Dr. Liaw of National Yang-Ming Chiao-Tung University Hospital in Yi-Lan, Taiwan, has no relevant financial relationships to disclose.
See Profile

Editor

Shuu-Jiun Wang MD

Dr. Wang of National Yang-Ming University and Taipei Veterans General Hospital received research grants from AbbVie, Lundbeck, Pfizer, Novartis, and Orient Europharma as principal investigator. He received speaker honorariums from AbbVie, Biogen, Eli Lilly, Hava Biopharma, and Pfizer.
See Profile

Former Authors

Patricia Pozo-Rosich MD PhD
Alicia Alpuente MD

This is an article preview.
Start a Free Account
to access the full version.

Nearly 3,000 illustrations, including video clips of neurologic disorders.
Every article is reviewed by our esteemed Editorial Board for accuracy and currency.
Full spectrum of neurology in 1,200 comprehensive articles.
Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660

Support: service@medlink.com

Editor: editor@medlink.com

ISSN: 2831-9125

Approach to headache patient

Also Relevant

Headache guidelines
Migraine

Clinical Categories

Headache & Pain

Approach to headache patient

Approach to headache patient

Cite this article

Introduction

Overview

Key points

Approach

Diagnosis

Therapeutic management

Education in headache

Treatments on the horizon

Special considerations

Media

References

Contributors

Author

Editor

Former Authors

This is an article preview.
Start a Free Account
to access the full version.

Questions or Comment?

Also in This Category

Suzetrigine

Atogepant

Headache associated with HIV and AIDS

Primary exercise headache

Chiropractic manipulation: neurologic complications

Headache associated with intracranial infection

Myofascial pain syndrome

Femoral neuropathy

Approach to headache patient

Cite this article

Introduction

Overview

Key points

Approach

Diagnosis

Therapeutic management

Education in headache

Treatments on the horizon

Special considerations

Media

References

Contributors

Author

Editor

Former Authors

This is an article preview. Start a Free Account to access the full version.

Questions or Comment?

Also in This Category

Suzetrigine

Atogepant

Headache associated with HIV and AIDS

Primary exercise headache

Chiropractic manipulation: neurologic complications

Headache associated with intracranial infection

Myofascial pain syndrome

Femoral neuropathy

This is an article preview.
Start a Free Account
to access the full version.