"I just want to know what is causing these headaches!" my patient said to me at our first visit. The stress she was experiencing over this subject was obvious. She was a 31-year-old mother of two who had been experiencing weekly frontal headaches over the past 18 months for no clear reason. She admitted that she had previously gotten the occasional headache, but these were usually mild, and responsive to over-the-counter pain medications. The head pain she now experienced was more severe and, at times, disabling. But the pain was not her main concern—it was the fear that something serious was happening to her. After finding a normal neurological exam, and later a normal MRI scan of her head, her worries subsided. A relatively simple program of medication and non-medicinal approaches reduced her headache frequency, and I was also able to help her find a successful pain reliever for the headaches, which turned out to be a form of migraine.
The patient above provides a good example of a common feeling many headache sufferers share: a fear that their pain may signify something much more ominous. And it is easy to understand these fears given the publicity cancer, infectious diseases, stroke, and other illnesses capable of inducing head pain have received. In 1988, the Headache Classification Committee of the International Headache Society (IHS) established a classification schema for headaches. It listed 13 major headache categories with more than a hundred subdivisions.
I will discuss in this article features of the primary headaches, important causes of secondary headaches, and the approach physicians usually take to explore the causes of headache in their patients, including laboratory testing.
