Intended for healthcare professionals

Practice Masterclass for GPs


BMJ 2007; 334 doi: (Published 01 February 2007) Cite this as: BMJ 2007;334:254
  1. Geraint Fuller, consultant neurologist1,
  2. Claire Kaye, general practitioner2
  1. 1Department of Neurology, Gloucester Royal Hospital, Gloucester
  2. 2London
  1. Correspondence to: C Kaye clairekaye2003{at}

    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 β 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 people are absent from school or work because of migraine, with a cost to the economy that may exceed £1.5bn (2.3bn euros, $2.9bn) a year.1

    What should I already know about this condition?

    Most headaches are benign, with tension-type headaches and migraines being the main sorts.

    Tension-type headaches are the most common type of headache, with the lifetime prevalence ranging between 30% and 78% according to different studies.

    Migraine can occur with or without an aura. A typical aura lasts from five to 60 minutes before the headache starts. It consists of transient visual, sensory, and speech disturbances. Visual symptoms are the most common manifestation of an aura and consist of flickering lights, spots or lines, or blind spots.

    Cluster headaches are unilateral severe headaches that occur in clusters over six to 12 weeks. They are more common in men, people who smoke, and adults older than 20 years. They tend to occur daily and wake …

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