BMJ  2007;334:254-256 (3 February), doi:10.1136/bmj.39090.652847.DE

Practice

Masterclass for GPs

Headaches

Geraint Fuller, consultant neurologist1, Claire Kaye, general practitioner2

1 Department of Neurology, Gloucester Royal Hospital, Gloucester , 2 London

Correspondence to: C Kaye clairekaye2003@yahoo.co.uk

The first 150 words of the full text of this article appear below.

Introduction


Practical tips

  • Headaches are a major cause of morbidity, but specific management can help
  • Make a diagnosis by taking a clear history and conducting a good examination as recommended by the British Association for the Study of Headache
  • Patients may have more than one type of headache
  • Be alert for medication overuse headache (patients using analgesics or triptans for >17 days a month are at risk)
  • For migraine, try to identify triggers and advise the patient to avoid them, make an acute treatment plan (analgesics with or without antiemetics or triptans), and consider prophylaxis (initially beta blockers or amitriptyline)


Headaches are one of the commonest reasons for attending a general practice or a neurology clinic. Some 15% of the UK adult population have migraine, and 80% have episodic tension-type headache from time to time. The lifetime prevalence of headache is 96%, being higher in women than in men. Every day more than 100 000 . . . [Full text of this article]

What should I already know about this condition?

What new evidence do I need to know about?

What new guidelines have been produced over the past three years?

Box 1: Taking a headache history (from BASH management guidelines1)
Box 2: Treatment ladder for migraine

Practical management tips

When should I refer my patient?

Common pitfalls


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