Headache and facial pain

Headache (any pain involving the neck and upwards, including the face) is the commonest neurological presentation, accounting for >25% of new outpatient neurology referrals. It makes up a significant proportion of GP and A&E attendances, and costs the health service more than Parkinson's disease, neuromuscular disease and other neurological conditions combined. Understanding the presentation and management of headache disorders is important in timely diagnosis, excluding worrying secondary causes, limiting morbidity and reducing unnecessary or lengthy hospital admissions. Facial pain is often regarded as separate from headache, with patients assessed in specialities such as ENT and maxillofacial surgery. Although dental and sinus pathology causes pain, migraine and other primary headaches can include, or exclusively involve, the face. Headache disorders are often incorrectly ascribed to a neck problem, but neck involvement in headache disorders is common and should not detract from the headache diagnosis. Migraine is the most common acute headache. It affects 20% of people, and many more experience some migraine symptoms during their life. It is one of the most disabling disorders according to the World Health Organization, and has significant socioeconomic impact for sufferers at the prime of their working lives. This article summarizes assessment, focusing on taking a complete headache history, to ensure correct and timely diagnosis.