ABSTRACT
There can be few more rewarding experiences in clinical medicine than correctly diagnosing and successfully treating a patient with a severe, recurrent and disabling headache problem, particularly when that patient may have followed previously the all too common ‘‘circuit of diagnostic destitution’’— optician, dentist, ENT surgeon, physical therapist, and so forth-without benefit. On the other hand, there are few more frustrating experiences for a physician than to be faced with a patient who has headache ‘‘all day every day’’ that is refractory to each and every intervention. There is nothing to see or measure, no ‘‘tests’’ to help to understand the basis of the problem.
