ABSTRACT
Clinical assessment still has a significant role to play in identifying and excluding secondary headaches. This has been dealt with in previous reviews (1). In essence, a good history and careful neurological and general physical examination remains the basis of such an assessment and, in large part, works best for primary headache disorders. It is important to have an approach to headache and to exclude red flags. However, the only way to truly identify or exclude secondary headaches is to investigate; neuroimaging is the most relevant investigative tool for yielding primary neurological etiologies. Nonneurological testing such as laboratory testing and imaging outside the nervous system still have a role to play, but frequently there are signs and symptoms of a nonneurological etiology. For the most part this chapter will deal with neuroimaging. Neuroimaging is at best however, it is now a surrogate for good clinical assessment, becoming the actual standard to identify and exclude secondary headache etiologies. The other strategies for subsidiary investigation will be discussed when appropriate.
