November 6, 1981

Evaluation of Headache-Reply

Author Affiliations

University of Washington School of Medicine Seattle

JAMA. 1981;246(18):2032. doi:10.1001/jama.1981.03320180023017

In Reply.—  As we stated in our article, a rare patient with brain tumor may have a headache and a normal neurological examination. However, such patients must be uncommon, as noted in our article and that of Lance et al.1 We are not surprised that neurosurgeons see such patients in addition to patients with third ventricle cysts, subdural hematoma, and brain abscesses. The authors of the two letters perform a service for the practicing physician who sees headache patients by describing some clinical features of such patients. The problem is deciding which patients to scan from among the many patients having headaches.Our study found that abnormal findings on neurological examination distinguished patients with mass lesions from other patients. The findings alluded to by Drs Ordia, Mark, and Myers are important ones but would be more useful if presented in the broader context of all headache patients. For example,