Clinical Case Database / Category: Patient Management

Assessment of patients complaining of headache

Publication details

Richard Peatfield
Foundation Years Journal, volume 8, issue 3, p.10 (123Doc Education, London, March 2014)


Migraine is extremely common. 6% of men and 15% of women have migraine fulfilling the official criteria of the International Headache Society, while up to 70-80% of the population have milder headaches that probably have a similar mechanism, and certainly respond to the same range of analgesic drugs (1). The vast majority of patients attending neurology clinics complaining of headache without other symptoms or any physical abnormalities have migraine; often the best approach is to ask about headache, abdominal pain and even motion sickness in their adolescent years! A small proportion do have other significant diseases, including subarachnoid haemorrhage, meningitis, temporal arteritis, cervical spondylosis, idiopathic intracranial hypertension, sinusitis and variants of migraine such as cluster headache and the various hemicranias.

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Richard Peatfield

Consultant Neurologist
Charing Cross Hospital
Fulham Palace Road
London W6 8RF


1. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991;44:1147-57.
2. Grant R Overview: Brain tumour diagnosis and management Royal College of Physicians
guidelines J Neurol Neurosurg Psychiatry 2004 75 (Suppl II): ii18–ii23.
3. Vázquez-Barquero A, Ibáñez FJ, Herrera S, Izquierdo JM, Berciano J, Pascual J Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study Cephalalgia 1994 14, 270–271.
4. Sempere A, Porta-Etessam J, Medrano V, Garcia-Morales I, Concepcion L, Ramos A, et al.
Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia 2005; 25: 30-35.
5. Kernick DP, Ahmed F, Bahra A, Dowson A, Elrington G, Fontebasso M, Giffin NJ, Lipscombe S,
MacGregor A, Peatfield R, Weatherby S, Whitmarsh T, Goadsby PJ. Imaging patients with suspected brain tumour: guidance for primary care. Br J Gen Pract. 2008 Dec; 58: 880-5


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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