Headache

Migraine is an episodic brain disorder that affects about 15 per cent of the population (Lipton et al. 2001; Steiner et al. 2003), can be highly disabling (Menken et al. 2000), and has been estimated to be the most costly neurological disorder in the European Community at more than €27 billion per year (Andlin-Sobocki et al. 2005). It is the most common reason for neurological referral in the United Kingdom, estimated by the Association of British Neurologists to drive 20 per cent of referrals in outpatients; epilepsy is next at 12 per cent. Unfortunately, there is a tacit assumption that doctors in general just understand headache, and that neurologists in particular have special knowledge and training in the field. Sadly this is most often not the case and they learn on the job often perpetuating mistakes of their supervisors. To manage headache can be a source of extreme frustration or undiluted pleasure; the difference simply reflects how much one knows about the subject. Readers encouraged either by this text or by their clinical experience can look more deeply into headache with detailed texts (Goadsby and Silberstein 1997; Silberstein et al. 2002; Lance and Goadsby 2005; Olesen et al. 2005).