Introduction

Too often, patients with headache are referred from general practice to a neurologist on the assumption (frequently specifically requested) that investigation is necessary for the diagnosis. Nothing is further from the truth. Patients with chronic headache, whether recurrent or persistent are diagnosed on the basis of their history, not on investigation. Most headache and facial pain syndromes are stereotypical (eg trigeminal neuralgia, cranial arteritis) and though investigation may be valuable as a confirmatory measure (an elevated ESR and an abnormal temporal artery biopsy in cranial arteritis, for example) they supplement rather than replace accurate history taking.