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HEADACHE

Common presenting complaint. May be benign or need urgent assessment. Taking an accurate history is important.

Main primary headaches (no identifiable underlying cause)

  • tension-type headache
  • migraine
  • cluster headache

Main secondary headaches (underlying cause identified; generally not life-threatening) are related to:

  • a substance or its withdrawal
  • head or neck trauma
  • psychiatric disorder

NICE CG150. Headaches in over 12s: diagnosis and management; 2012 (updated 2921).  https://www.nice.org.uk/guidance/CG150

British Association for the Study of Headache (BASH). BASH guidelines https://www.bash.org.uk/guidelines/  

International Headache Society (IHS) classification (ICHD-3) https://ichd-3.org/evolution-of-ihs-classification-1-3/

Practice Nurse featured article 

Headache and migraine in young people and adults. Dr Knut Schroeder & Sara Richards 

The child with a headache Dr Mary Lowth 

MIGRAINE

A syndrome characterised by periodic headaches - from a few a week, to a few within a lifetime, with complete resolution between attacks. A migraine episode/attack may comprise:

  • prodrome (vague change noted in appetite or mood
  • aura (a neurological symptom - may be motor, visual or other sensory disturbance)
  • headache
  • resolution

SIGN 155. Pharmacological management of migraine; 2018 https://www.sign.ac.uk/sign-155-migraine

HEADACHE Red Flags raising concern of serious pathology

  • Thunderclap headache
  • Morning headache
  • Headache associated with vomiting
  • Unilateral headache and eye pain
  • Unilateral headache and ipsilateral symptoms
  • Cough-initiated headache
  • Recent and persisting headache in patients over 50 yrs
  • Change in pattern of usual headache

Urgent referral

  • New headache with non-acute onset progressively worsening
  • Headache with fever or neck stiffness
  • First or worst headache
  • Decreased level of consciousness
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