title: European Headache Federation consensus on technical investigation for primary headache disorders.
abstract: The diagnosis of primary headache disorders is clinical and based on the diagnostic criteria of the International Headache Society (ICHD-3-beta). However several brain conditions may mimic primary headache disorders and laboratory investigation may be needed. This necessity occurs when the treating physician doubts for the primary origin of headache. Features that represent a warning for a possible underlying disorder causing the headache are new onset headache, change in previously stable headache pattern, headache that abruptly reaches the peak level, headache that changes with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre, first onset of headache ≥50 years of age, neurological symptoms or signs, trauma, fever, seizures, history of malignancy, history of HIV or active infections, and prior history of stroke or intracranial bleeding. All national headache societies and the European Headache Alliance invited to review and comment the consensus before the final draft. The consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. Persistent aura without infarction and migrainous infarction require brain MRI, MRA and MRV. Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all TACs. For primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required. Because there is little and no good evidence the committee constructed a consensus based on the opinion of experts, and should be treated as imperfect.
authors: Neurology Department, Athens Naval Hospital, Athens, Greece. dimosmitsikostas@me.com.
authors: D D
authors: DD
authors: Mitsikostas
authors: Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. ashina@dadlnet.dk.
authors: M
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authors: Ashina
authors: European Headache Alliance, President, Dublin, Ireland. audreycraven@migraine.ie.
authors: A
authors: A
authors: Craven
authors: Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany. hans.diener@uk-essen.de.
authors: H C
authors: HC
authors: Diener
authors: Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, and King's Clinical Research Facility, Kings College London, Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK. peter.goadsby@kcl.ac.uk.
authors: P J
authors: PJ
authors: Goadsby
authors: Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. M.D.Ferrari@lumc.nl.
authors: M D
authors: MD
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authors: Medical Headache Center, Hospital Sisters of Mercy, Seilerstaette Linz, Linz, 4020, Austria. christian.lampl@bhs.at.
authors: C
authors: C
authors: Lampl
authors: Department of Neurology, Ghent University Hospital, Ghent, Belgium. Koen.Paemeleire@uzgent.be.
authors: K
authors: K
authors: Paemeleire
authors: University Hospital Marqués de Valdecilla and IDIVAL, 39011, Santander, Spain. juliopascual@telefonica.net.
authors: J
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authors: Pascual
authors: Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey. akselsiva@gmail.com.
authors: A
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authors: Siva
authors: Danish Headache Centre and Department of Neurology, Rigshospitalet, Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. jes.olesen@regionh.dk.
authors: J
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authors: Department of Neurology, First Moscow State Medical University, Moscow, Russia. osipova_v@mail.ru.
authors: V
authors: V
authors: Osipova
authors: Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy. paolo.martelletti@uniroma1.it.
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authors: Martelletti
mesh_terms: D051270:Headache Disorders, Primary / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging; D010808:Physical Examination
keywords: Brain MRI; Consensus; Diagnostic tests; Migraine; Primary headache disorders; TACs; Tension-type headache