1. Headaches
Jo swallow

2. 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

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

4. 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

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

6. 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

7. 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

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

9. 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

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

11. 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

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