Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- generalised head pain
- frontal or occipital head pain
- non-pulsatile head pain
- constricting pain
- normal neurological examination
Other diagnostic factors
- pericranial tenderness
- sternocleidomastoid muscle tenderness
- trapezius muscle tenderness
- temporalis muscle tenderness
- lateral pterygoid muscle tenderness
- masseter muscle tenderness
- photophobia or phonophobia
- nausea
- regular analgesic use
- anxiety and depression
- somatisation
Risk factors
- mental tension
- stress
- missing meals
- fatigue
- lack of sleep
- somatisation
- female sex
- age 20-39 years
- lower socioeconomic status
- analgesic overuse
Diagnostic investigations
Treatment algorithm
Contributors
Authors
Mark W. Green, MD, FAAN
Professor of Neurology, Anesthesiology and Rehabilitation Medicine
Emeritus Director of Headache and Pain Medicine
Icahn School of Medicine at Mount Sinai
New York
NY
Disclosures
MWG declares that he has no competing interests.
Rachel Colman, MD
Assistant Professor of Neurology
Icahn School of Medicine at Mount Sinai
New York
NY
Disclosures
RC declares that she has no competing interests.
Peer reviewers
Sait Ashina, MD
Assistant Professor of Neurology and Anesthesia
Harvard Medical School
Director of Comprehensive Headache Center
Beth Israel Deaconess Medical Centre
Boston
MA
Disclosures
SA has received honoraria from and is a consultant for Abbvie/Allergan, Eli Lilly, Linpharma, Lundbeck, Satsuma, Teva, Theranica, Percept, and Impel NeuroPharma. SA is an author of one of the references in this topic.
Giles Elrington, MBBS (Hons), MD, FRCP
Consultant Neurologist
Barts Health NHS Trust
London
UK
Disclosures
GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences, and symposia with the following companies: GSK, AstraZeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, BMJ.
Paul Davies, MA, MD, FRCP
Consultant Neurologist
Northampton General Hospital
Northampton
UK
Disclosures
PD declares that he has no competing interests.
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