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

Practice

Masterclass for GPs

Headaches

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

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 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?

Features of medication overuse headache²
Bottom line
Topiramate in migraine prevention³
Bottom line

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

British Association for the Study of Headache (BASH) management guidelines (2004)¹
Diagnosis
Treatment of migraine
Prophylaxis of migraine
Box 1: Taking a headache history (from BASH management guidelines¹)
Box 2: Treatment ladder for migraine
European Federation of Neurological Societies guideline on the drug treatment of migraine⁴

Practical management tips

Managing migraine

When should I refer my patient?

Common pitfalls

Commonly asked question—answered
Will my patient benefit from having a scan, even if I do not think he or she has intracranial pathology (a primary headache syndrome)?
Further educational resources
BMJ Learning: www.bmjlearning.com

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