Published 20 November 2008, doi:10.1136/bmj.a2445
Cite this as: BMJ 2008;337:a2445

Practice

Commentary: Controversies in SIGN guidance on diagnosing and managing headache in adults

Giles Elrington, consultant neurologist

1 Barts and The London NHS Trust, London E1 1BB

elrington@aol.com

doi:10.1136/bmj.a2329

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

A discussion of headache centres on two largely independent areas: diagnosis of possible serious cause (usually none is found), and pain management (typically less, not more medication is needed). The newly published guideline from the Scottish Intercollegiate Guidelines Network (SIGN)1 uses the familiar split of primary and secondary headache—that is, benign and serious headache.

It is unusual for headache to be the sole symptom of brain tumour.1 The guideline omits demographics: the approximate risk of brain tumour or other serious cause for headache is 1:1000 for headache presenting in primary care, 1:100 for headache presenting in secondary care (outpatients), and 1:10 for headache presenting in accident and emergency departments.

The guideline lists familiar "red flag" indications.1 Reassurance from a scan is supported by a single, unblinded study showing benefit at three months but not at one year.2 The guideline discusses risks of imaging, not confined to computed tomography ionising radiation. . . . [Full text of this article]


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Relevant Article

Diagnosis and management of headache in adults: summary of SIGN guideline
C W Duncan, D P B Watson, A Stein on behalf of the Guideline Development Group
BMJ 2008 337: a2329. [Extract] [Full Text]

Rapid Responses:

Read all Rapid Responses

Evidence based commentaries?
Andrew T Elder
bmj.com, 23 Nov 2008 [Full text]
Clarification
Callum W Duncan, et al.
bmj.com, 25 Nov 2008 [Full text]
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