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  • Migraine.
    • Headache lasting 4-72 hours.
    • Unilateral onset often spreading bilaterally.
    • Pulsating quality and moderate or severe intensityof pain.
    • Aggravated by or inhibiting physical activity.
    • Nausea and photophobia.
    • May present with an aura.
  • Cluster headache.
    • Strictly unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes.
    • Explosive excruciating pain.
    • One attack every other day to eight attacks per day.
  • Tension-type headache.
    • Pressing or tightening (nonpulsating) pain.
    • Bilateral band-like distribution of pain.
    • Not aggravated by routine physical activity.

General Considerations

Headache is among the most common pain syndromes presenting in primary care with a lifetime prevalence of over 90% among adults. The prevalence of migraine is approximately 18% in women and 6% in men; the prevalence among both genders is 38.3% for episodic and 2.2% for chronic tension-type headache. The main task before the primary care provider is to determine if the patient has a potentially life-threatening headache disorder and, if not, to provide appropriate management to limit disability from headache.

A distinction between primary headaches (benign, recurrent headaches having no organic disease as their cause) and secondary headaches (those caused by an underlying, organic disease) is practical in primary care. Over 90% of patients presenting to primary care providers have a primary headache disorder (Table 28-1). These disorders include migraine (with and without aura), tension-type headache, and cluster headache. Secondary headache disorders comprise the minority of presentations; however, given that their underlying etiology may range from sinusitis to subarachnoid hemorrhage, these headache disorders often present the greatest diagnostic challenge to the practicing clinician (Table 28-2).

Table 28-1. Primary Headache Disorders.
Table 28-2. Secondary Headache Disorders.

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