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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

Headaches: diagnosis and management of headaches in young people and adults. NICE CG150, 2012. Guideline and pathway. https://guidance.nice.org.uk/CG150

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

International Headache Society (IHS) classification (ICHD-II) https://ihs-classification.org/en/

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

Diagnosis and management of headache in adults SIGN 107, 2008. https://www.sign.ac.uk/pdf/sign107.pdf

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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