Persistent headache on most days over a four week period
No worrying features
No associated symptoms
No associated high risk conditions
Normal neurological examination
Review/refer
Headache duration less than four weeks
No worrying features
No associated symptoms
No associated high risk conditions
Normal neurological examination
Scan
Headache with worrying features
Headache with abnormal neurological examination
Headache with associated high risk condition
Headache with one or more other symptoms from symptom checklist
Diagnostic pitfalls
Delayed diagnosis has occurred when a complete reassessment is not undertaken with a change in headache type in a known sufferer of migraine or tension headaches
Examination/assessment
Determine duration and characteristics of headache
Ask specifically about associated symptoms and risk factors:
Personal or family history of a brain tumour
Leukaemia
Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
Neurofibromatosis types 1 and 2
Tuberous Sclerosis
Li Fraumeni Syndrome
Family history of colorectal polyposis
Gorlins Syndrome
Other familial genetic syndromes
Neurological examination (include assessment of vision (including acuity), gait and coordination)