Chronic Headache and facial pain

Over 99% of cases of  chronic headache and facial pain are classified as primary headache. In other words, the headache itself is the primary condition, and it is not being caused by something else in the head, like a tumour or a bleed. For this reason, in the vast majority of cases of chronic headache and facial pain, a brain scan will be normal and will not have any diagnostic value (other than reassurance).

Furthermore, there are no diagnostic blood tests for the majority of cases of chronic headache and facial pain and physical examination is also often normal. This means that we usually diagnose chronic headache and facial pain by the description of the pain and compare this against recognised  diagnostic criteria. This, however, can be further complicated by the possibility that two types of headache may be present at the same time, an overlap of symptoms or an atypical presentation of the headache.

People with a chronic headache are often, understandably, anxious to get a brain scan to help make the diagnosis. While this is usually not necessary, there are occasions when this is needed. To help decide if a brain scan is needed, there are a number of features about the headache that might give a clue that this is caused by another condition.

• SYSTEMIC SYMPTOMS –  ie fever, weight loss, night sweats
• NEW NEUROLOGICAL SYMPTOMS OR ABNORMAL SIGNS –  ie confusion, localised weakness or numbness, impaired consciousness)
• SUDDEN ONSET- ie  abrupt, or split-second (Thunderclap headache)
• ONSET AT AN OLDER AGE-  ie new onset and progressive headache, especially in middle i.e. age over 50 years eg giant cell arteritis
• CHANGING HEADACHE HISTORY-  ie a change in pattern of an existing or established headache
• SIGNS OF INFECTION –  i.e. fever, confusion,  stiff/sore neck, sensitivity to bright light
• TRAUMA – ie recent head injury