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Headache Assessment and Management
Kaniecki R.
Posted: November 2003  
JAMA. 2003;289:1430-1433

The lifetime prevalence of headache is more than 90%. In recent population-based surveys of adults, nearly 25% annually report episodes of severe headache and 4% daily or near-daily headache. Prescription or non-prescription products are used by 9% of US adults every week to treat headache, matching hypertension as the primary reason for medication use. The majority of patients presenting to physicians will have primary headache syndromes such as tension-type, cluster, and migraine. Less than 2% of patients in office and 4% of patients in emergency department settings will be found to have headaches secondary to significant pathology.

Conclusion:   Consensus exists regarding the importance of patient education in migraine. Physicians should review the biological basis and genetic underpinnings of the sensitive nervous system responsible for migraine. A discussion of the risks, benefits, and realistic expectations from acute and preventive medications is imperative. Encouraging active participation in care through lifestyle suggestion and headache calendar completion is useful. Diaries documenting headache events, triggers, and response to treatments are indispensable in monitoring progress on a regular basis. Successful outcomes often arise from a vigorous therapeutic partnership between patient and physician.