In the
UK, 4% of general practitioner consultations are for
headache, yet the natural history of these presentations is unknown. The objective of this study was to describe the outcome of new
headache presentations to the general practitioner. This was a prospective case-control study in adults over a period of 1 year using data from the General Practitioner Research Database, UK. Records of patients who presented with primary
headache (migraine,
tension-type headache,
cluster headache) or undifferentiated
headache (no further descriptor) were examined for the subsequent year for subarachnoid haemorrhage, primary brain tumour, benign space-occupying lesion,
temporal arteritis,
stroke and transient ischaemic attack. We identified 21,758 primary
headaches and 63,921 undifferentiated
headaches. The likelihood ratio was 29 (9.9, 92) for a subarachnoid haemorrhage after an undifferentiated
headache and increased with age. The 1-year risk of a malignant brain tumour with new undifferentiated
headache was 0.15%, rising to 0.28% above the age of 50 years. For primary
headache the risk was 0.045%. The risk for a benign space-occupying lesion was 0.05% for an undifferentiated and 0.009% for a primary
headache. The risk of
temporal arteritis was the highest of the conditions studied, 0.66% in the undifferentiated and 0.18% in the primary
headache group. Accepting the limitations of this approach, our data can inform management guidelines for new presentations of
headache in primary care and confirm the need for follow-up, even if a primary
headache diagnosis is made.