22. Headache and facial pain

Headache is a common complaint in both primary and secondary care. Careful history-taking is the most important tool for diagnosing it. Some types respond well to treatment, others are virtually intractable to standard treatments. A general discussion of headache (sect. 22.1) is followed by a detailed consideration of migraine (sect. 22.2). We then look at cranial neuralgias (sect. 22.3) and cluster headache (sect. 22.4). Temporal arteritis is somewhat beyond the scope of this chapter but it should not be missed and is therefore described briefly in sect. 22.5. Tension-type headache and migraine are the most common types (sect. 22.6). It is important to recognize medication-dependent headache (sect. 22.7). There can sometimes be a potentially serious underlying cause (symptomatic headache), especially if the pain is acute (sect. 22.8). Clinicians need to be on the lookout for red-flag symptoms (sect. 22.9).