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Headaches - In Primary Care Dr M Banerjee GP Registrar Tadworth
Main Types Tension Headache Migraine Cluster Headache OR Secondary to underlying cause
History Duration Quality – Dull/stabbing/continuousAssociated features Triggers/relieving factors Use of drugs/complementary medicines and/or caffeine Psychological
Examination General- s/he looks unwell? Measure BP Neurological incl fundoscopy Head and neck
Secondary Headaches Intracranial lesion Meningitis Subarachnoid haemorrhage Acute close angle glaucoma Temporal arteritis
Red flag signs Increased ICP Focal neurological signs Constitutional signs Intensity- “worst headache of my life” Head injury New onset – age > 50 yrs
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
Migraine Visual aura -> throbbing Episodic severe Photophobia, nausea,vomiting Precipitating factors Symptom diaries
Tension Associated with stress & anxiety Usually worse at end of day Like a tight band around head
Cluster- management 100% O2 Ergotamine or triptan nasal spray Intranasal lidocaine Verapamil – prophylaxis May need neurologist referral
Migraine Acute- Analgesics Sumatriptan/ Rizatriptan Prophylaxis- Beta blockers TCA SSRI Ca channel blockers Pizotifen
Tension - management Reassure NSAIDS – avoid opioids Lifestyle modifications
Analgesic Rebound Daily headache Regular use – usually multiple Age 30-40; More in females (5:1) 20% of all chronic headaches Management: withdrawal of all analgesics Patient education/psychological support
Clinical Manifestations Progressive headache – No history of infection – Lack of fever, GI and urinary problems – Unremarkable laboratory work-up – Increasing.
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