Answer #4 - Much depends on the headache history. When a patient comes into my office by the time I have finished taking their history, the diagnosis is made 90% of the time. It’s very rare that by the time I have sat with the patient and taken the history that I cannot make the diagnosis.

The concern is when a patient comes in and there’s a headache that starts for the first time if there’s a change in the pattern of the headache history, there are certain things in the headache that we call red flags and there may be some worrisome things in the headache history that the patient gives us; there may be some things that the patient says that raises the alarms for us and that’s when we tend to be concerned and that’s when consider investigating the patient.

And so there are things about the patient we are concerned about where we will investigate. But I would say for the most part that most patients who present with a long history of migraine headache when they come to see us most patients tend not to be investigated unless there is a reason for concern. Now there are many patients that need reassurance and if they can't be reassured by a normal exam and by seeing a specialist then we tend to discuss that with them individually and make a decision based on that.