Headaches in Adults in Primary Care Evaluation, Diagnosis, and Treatment

Headaches are common in primary care practices with 90% of primary headaches being either tension-type headache or migraine headache. The diagnosis is made by a careful history and physical with particular attention to the identification of red flag signs and symptoms. Imaging is generally not warranted unless concerning findings are identified. Several general principles underlie the acute treatment of either type of headache with early initiation of therapy and adequate dosing at first dose. Careful attention to avoid too frequent administration of acute therapy is important to minimize medication overuse headaches. Opioids should always be avoided. Preventive treatment is indicated for frequent headaches of either type, but the data are better to support the prevention of migraine headache. Successful treatment requires the initiation of low-dose medication with careful titration and monitoring of headache frequency over months. Finally, behavioral strategies are important in both types of headache and should be a part of any comprehensive headache management plan.

Automated summary

Headaches are common in primary care practices, with tension-type headaches and migraine headaches being the most prevalent. Imaging is generally unnecessary unless concerning findings are identified. The principles of acute treatment include early initiation of therapy and adequate dosing to avoid medication overuse headaches.