Walsh & Hoyt: Approach to Headache and Facial Pain

Headache and facial pain result from disorders that affect the pain-sensitive structures in the head and neck, such as meninges, blood vessels, and muscles. Pain-sensitive structures responsible for head and facial pain are listed. A history is the first and most important step in the evaluation of head and facial pain; the examination and any ancillary tests serve to confirm or exclude what is already suspected. In many patients with headache and facial pain, the general neurologic and ophthalmologic examination is normal, and the correct diagnosis rests upon a thorough and accurate history. Most, but by no means all, of the more serious and life-threatening causes of headache present with acute onset of pain: a patient with his or her ""first or worst"" headache has a greater likelihood of harboring an ominous cause for the head pain than someone with a 10-year history of recurrent, low-grade headache that has not changed in character. Although a chronic and recurrent headache is more likely to represent a benign condition, patients with a headache distinct from previous headaches (in terms of location or quality of pain) are also more likely to harbor a serious underlying illness.