Traditional Neurology fortified with Advanced Headache Neurology

Traditional neurology relies on history and examination to generate a hypothesis of the localisation and aetiology of the disease process. The hypotheses generated in headache medicine is often limited when it is not combined with the syndromic approach that is used in traditional neurology. The diseases which fall within the syndrome are then confirmed by additional history, examination and investigations derived from advances in the field of headache medicine. This fortification will reduce knowledge gap among clinicians. Patient advocacy and empowerment will also benefit by disseminating this enhanced knowledge. Traditional neurology relies heavily on the clinical history with which seasoned clinicians often localize the lesion somewhere in the neuraxis and also postulate the etiopathogenesis. This is followed by a focused clinical examination that often confirms the hypothesis derived from the history, although there may be a few surprises now and then. Investigations are extensions of the clinical examination and may not be fruitful, or even be misguiding if done without a hypothesis, as it may pick up a needle in the haystack instead of the bothersome rat. Traditional neurology relies heavily on the clinical history with which seasoned clinicians often localize the lesion somewhere in the neuraxis and also postulate the etiopathogenesis. This is followed by a focused clinical examination that often confirms the hypothesis derived from the history, although there may be a few surprises now and then. Investigations are extensions of the clinical examination and may not be fruitful, or even be misguiding if done without a hypothesis, as it may pick up a needle in the haystack instead of the bothersome rat. In headache medicine too, this approach has been followed all along. However what has been lacking is a detailed head and neck examination which neurologists often delegate to expert colleagues in the field of ophthalmology, ENT and oral surgery. This is because headachemedicine has been traditionally a subspecialisation of neurology and the 4 step examination of higher mental functions, cranial nerves, motor system and sensory system are the mainstay. By and large this maybe sufficient, and is also reinforced by the general perception that clinical examination contributes very little in headache disorders, unlike, say, neuromuscular disorders. The problem with this approach arises when the patient encounters a headache medicine expert, half of whose armamentarium lieswith other specialists.This void needs to be filled. Fast forward 21st century headache neurology and there is a new breed of headache specialists whose clinical skills are reinforced by training in neuro-ophthalmology, radiology and head and neck surgery. © 2021 Published by World Headache Society. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)