Headaches Jo swallow

Why is this important? Prevalence of headache is very high (96%) Most common headaches are tension-type headache (TTH), migraine and chronic primary headaches Migraine is associated with high economic costs Headaches are a frequent reason for GP consultation However, migraine is under-diagnosed and under-treated in the UK

Migraine, acute attack, Aspirin 900mg soluble/Ibuprofen 600mg soluble Domperidone (regardless of nausea) Tryptan (paracetemol if can’t have NSAID)

Migraine treatment prevention Features of medication overuse headache (MOH) Nice guidance, vs reality Amitryptilline/nortriptilline Atenolol/Propranolol Topiramate is an effective and generally well tolerated new preventive drug for migraine Gabapentin

Migraine and the pill ?what do you know re this. ?tryptans and ssris/tca’s? ?tryptans and the pill.

Practical management tips Seven step process for managing headache Screening Patient education and eliciting commitment Differential diagnosis Assessment of illness severity Tailoring management to the needs of the individual patient Proactive, long-term follow up A team approach to care

diagnostic features of secondary headaches, (RED FLAGS) Could it be a brain tumour? Only 50% of brain tumours present with headache, of these, 80% will have other signs, such as.......

Cognitive issues, Vomiting, Balance problems/dizziness Neurological deficits, Gait abnormalities, Dysphasia Personality changes Seizures

When should I refer my patient? <5 years or >60 years Nb change in head circumference in children/school regression, prolonged vomiting in child. New-onset or acute headaches Single, sudden severe headache – discuss. Progressive headaches History of cancer Symptoms: rash, non-resolving neurological deficit, vomiting outside of the headache, scalp pain/tenderness, accident/head injury, infection, worrisome hypertension Uncertain diagnosis Refractory to repeated acute and preventive treatments Very anxious despite reassurance

Commonly asked questions Will my patient benefit from having a scan, even if I do not think there is intracranial pathology? VOMIT.

Common pitfalls Misdiagnosing chronic headache as migraine Over-treating chronic headaches leading to MOH Under-treating migraine – relying on analgesics Missing unusual primary headache variants Blaming headaches solely on stress

Important messages Most headaches can be managed effectively in primary care Headaches are a major cause of morbidity Specific management of headaches can help