Clinical Review

Clinical reviewHeadacheCommentary: Headache in South America

BMJ 2002; 325 doi: (Published 19 October 2002) Cite this as: BMJ 2002;325:881


  1. T J Steiner, clinical reader (,
  2. Manuela Fontebasso, general practitionerb
  1. aDivision of Neuroscience, Imperial College, London W6 8RP
  2. bFront Street Surgery, Acomb, York YO24 3BZ
  3. Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil (09-01) 3734, Ecuador
  1. Correspondence to: T J Steiner

    A detailed systematic history is the key to diagnosing and effectively managing patients with this common and disabling condition

    Headache affects most people, at least occasionally. It is high among the reasons why people consult general practitioners and neurologists. 1 2 It may signal serious underlying illness, but, more importantly, it is associated with personal and social burdens of pain, disability, damaged quality of life, and financial cost. 3 4 It ought to be a huge public health issue, but headache receives little priority in the queue for healthcare resources.5

    The diagnosis and management of most headaches require neither advanced neurological skills nor investigations.

    Sources and selection criteria

    We reviewed published and other accessible information sources, including the World Health Organization's world health report,6 major epidemiological surveys, the classification and diagnostic criteria of the International Headache Society,7 reports of clinical trials, and selected national management guidelines. We used the definitive textbook on headache disorders—The headaches—as a reference source.8 Treatment recommendations in the present paper were based on evidence but, other than for the newer drugs, this was often limited to expert opinion and practice.

    Diagnosing headache

    Sufficient time committed to a systematic headache history is the key to effective diagnosis (see box 1). The correct diagnosis is not always evident initially, especially when the patient has more than one type of headache. A diary kept for a few weeks can establish the pattern of attacks, symptoms, and medication use. A change in pattern signals something newK—aggravating circumstances, or the onset of a new headache disorder. New headache, in young and old patients, needs especially careful inquiry.

    Summary box

    • Headache disorders are common in general populations everywhere

    • They are potentially disabling, and impose heavy individual and societal burdens; appropriate effective management should have higher priority than it does at present

    • Most patients with …

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