Evaluation and treatment of headache. Practical approach to a common symptom.

Chronic headache pain has many causes but is generally attributed to one of three mechanisms: muscular contraction, vascular inflammation, or traction or inflammation of pain-sensitive structures. Because of the wide variety of headache types and the often-confusing terminology and classification systems in use, evaluation of headache can be difficult. A step-by-step approach to patient workup, including patient history, physical examination, and appropriate tests, can help the physician pinpoint the underlying problem and determine appropriate therapy. Long-term drug therapy is effective for most patients with vascular headaches. For headaches of psychogenic origin, therapy includes psychotropic drugs, biofeedback training, counseling, and behavior modification. More research in the area of mind-body interactions will lead to improved management of chronic headache of nonorganic origin.