BMJ  2004;329:469-470 (28 August), doi:10.1136/bmj.329.7464.469

Editorial

To scan or not to scan in headache

Some patients with primary headaches may need imaging

The first 150 words of the full text of this article appear below.

Some life threatening brain disorders present with secondary headache, where the headache is caused by the disease. A brain tumour, for example, is best diagnosed by brain imaging early in the course of the disease, which is essential for optimal management of this and other secondary headache disorders. However, brain tumours, as an example, account for less than 0.1% of the lifetime prevalence of headache.¹ This contrasts with the fact that most headaches in the community are either associated with mild systemic infection or due to primary headache,¹ where the headache is itself the disorder. Dissecting primary from secondary headache is the problem, since, by definition, primary headache does not need brain imaging because no disease process exists that leads to macroscopic change in general terms.

How does one dissect primary from secondary headache? This question can have only a clinical response since no controlled trials have been conducted to . . . [Full text of this article]

Institute of Neurology, University College London, London WC1N 3BG (peter@ion.ucl.ac.uk)

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