Headaches - In Primary Care

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Headaches -In Primary Care

• Dr M Banerjee
• GP Registrar
• Tadworth

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Main Types

• Tension Headache
• Migraine
• Cluster Headache
• OR
• Secondary to underlying cause

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History

• Duration
• Quality Dull/stabbing/continuousAssociated
  features
• Triggers/relieving factors
• Use of drugs/complementary medicines and/or
  caffeine
• Psychological

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Examination

• General- s/he looks unwell?
• Measure BP
• Neurological incl fundoscopy
• Head and neck

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Secondary Headaches

• Intracranial lesion
• Meningitis
• Subarachnoid haemorrhage
• Acute close angle glaucoma
• Temporal arteritis

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Red flag signs

• Increased ICP
• Focal neurological signs
• Constitutional signs
• Intensity- worst headache of my life
• Head injury
• New onset age gt 50 yrs

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Cluster Headaches

• Comoner in males and smokers
• Once or twice every 24 hrs
• Pain free intervals
• Rapid onset of severe pain
• Usually unilateral and same sided
• Pain around eye red eye lacrimation

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Migraine

• Visual aura -gt throbbing
• Episodic severe
• Photophobia, nausea,vomiting
• Precipitating factors
• Symptom diaries

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Tension

• Associated with stress anxiety
• Usually worse at end of day
• Like a tight band around head

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Cluster- management

• 100 O2
• Ergotamine or triptan nasal spray
• Intranasal lidocaine
• Verapamil prophylaxis
• May need neurologist referral

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Migraine

• Acute-
• Analgesics
• Sumatriptan/ Rizatriptan
• Prophylaxis-
• Beta blockers
• TCA
• SSRI
• Ca channel blockers
• Pizotifen

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Tension - management

• Reassure
• NSAIDS avoid opioids
• Lifestyle modifications

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Analgesic Rebound

• Daily headache
• Regular use usually multiple
• Age 30-40 More in females (51)
• 20 of all chronic headaches
• Management
• withdrawal of all analgesics
• Patient education/psychological support