More than just paracetamol
BMJ 2002; 324 doi: https://doi.org/10.1136/sbmj.0205142 (Published 01 May 2002) Cite this as: BMJ 2002;324:0205142
- Steven E Bradshaw, final year clinical student1,
- Isla S Mackenzie, senior clinical lecturer2,
- Christopher M C Allen, consultant neurologist3,
- Pavi Agrawal, final year clinical student4
- 1University of Cambridge
- 2Department of Clinical Pharmacology, Addenbrooke's Hospital, Cambridge CB2 2QQ
- 3Department of Neurology, Addenbrooke's Hospital
- 4University of Cambridge
Headaches are a universal human experience that can be disabling.1 Because they occur often, it is important to be familiar with the main types of headache and their management.
Primary and secondary headaches
Headaches are described as being either primary or secondary. Primary headaches include migraine, cluster, and tension-type headaches; they have no underlying causes that are readily identifiable. Clinical diagnoses, therefore, are based on features in the history, such as those defined by the International Headache Society (boxes 1 to 4).1 Secondary headaches are related to specific conditions (box 5).
Box 1: Migraine without aura
(a) At least five attacks fulfil (b), (c), and (d)
(b) Headaches last 4 to 72 hours (untreated or unsuccessfully treated)
(c) Headache has at least two of these characteristics: unilateral location; pulsating quality; moderate or severe intensity (inhibits or prohibits daily activities); aggravation by walking stairs or similar normal physical activity
(d) During headache, at least one of these symptoms: nausea or vomiting; photophobia and phonophobia
(e) No evidence of related organic disease
Box 2: Migraine with aura
(a) At least two attacks fulfil (b)
(b) Headache has at least two characteristics: one or more fully reversible aura symptoms indicating brain dysfunction; at least one aura symptom develops gradually over >4 min, or two or more symptoms occur in succession; no single aura symptom lasts >60 min;headache begins after aura with an interval of <60 minutes (it may also begin before or simultaneously)
(c) No evidence of a secondary disease
Box 3: Cluster headache
(a) At least 5 attacks fulfil (b), (c), and (d)
(b) Severe unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes untreated
(c) Headache associated with one of these signs on the side with the pain: conjunctival injection; lacrimation; nasal congestion; rhinorrhea; forehead and facial sweating; …
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