Headache affects nearly everyone at least occasionally. It is a problem at some time in the lives of an estimated 40% of people in the UK. It is one of the most frequent causes of consultation in both general practice and neurological clinics.

In its various forms, headache represents an immense socioeconomic burden.

Migraine occurs in 15% of the UK adult population, in women more than men in a ratio of 3:1.1 An estimated 190,000 attacks are experienced every day, with three

quarters of those affected reporting disability. Whilst migraine occurs in children (in whom the diagnosis is often missed) and in the elderly, it is most troublesome during the productive years (late teens to 50’s). As a result, over 100,000 people are absent from work or school because of migraine every working day.1 The cost to the economy may exceed £1.5 billion per annum. Tension-type headache in its episodic subtype affects up to 80% of people from time to time,2 many of whom refer to it as “normal” or “ordinary” headache. Consequently, they mostly treat themselves without reference to physicians using over-the-counter (OTC) medications and generally effectively. Nevertheless, it can be a disabling headache

over several hours3 and the high prevalence of this disorder means its economic burden through lost work and reduced working effectiveness is similar to that of migraine.4

In a minority of people, episodic tension-type headache is frequent, whilst up to 3% of adults have the chronic subtype5 occurring on more than 15 days every month. These people have high morbidity and may be substantially disabled; many