[The treatment of headache].

In symptomatic headache treatment is directed against the underlying disease. If this is impossible, its pathogenesis may still respond to treatment such as dexamethasone in inoperable brain tumor, simple psychotherapy in reactive emotional disorder due to intractability of the underlying disease, or migraine management where symptomatic headache is succeeded by migraine, as in posttraumatic headache. Primary headache-migraine, cluster headache, and cephalaea vasomotoria ("tension headache") require positive identification of the syndrome but this does not lead directly to proper treatment; assessment of severity and, where feasible, of the psychological situation is needed. The means are available to influence some of the mechanisms apparent in primary headache both by non-drug and by drug treatment, but the choice must allow for the fact that these methods are not specific but only a little more effective than placebo. Drug abuse is the principal danger in headache problems. It can be treated by tracking down the offending drug under cover of interval medication or, failing this, by abrupt withdrawal in a neurology ward followed by a period of several weeks' exile from the usual daily demands. A short description of drugs used in primary headache is given.