Be able to explain to the patient your understanding of the source of the headache in words that the patient can understand and that is reassuring to the patient. It is often appropriate to tell the patient that you can't explain the exact source or mechanism of the pain, but that you have reasonably ruled out ominous sources of the pain and will not pursue inappropriate testing such as CT and MRI for chronic tension type headache. Be able to offere the patient appropriate treatment and empathy, taking into consideration the medication cost and effect on the patient's life. General Comments Common complaint. Most are benign.
Greatest concern is over headaches that are persistent, severe, or sudden in onset.
The physician's most immediate task is to identify, on clinical grounds, the occasional patient who requires an aggressive work-up. Acute headaches are those that appear suddenly, often without prior history. Recurring headaches may be due to a chronic cause, such as emotional depression and tension, or may be the result of a migraine process. In patients with headache of a more prolonged time course, it is important to note any changes in the quality and severity of the pain and in the appearance of associated neurologic signs. Diagnostic Approach Good listening skills, with sufficient time and patience.