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Headaches - In Primary Care Dr M Banerjee GP Registrar Tadworth.

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Presentation on theme: "Headaches - In Primary Care Dr M Banerjee GP Registrar Tadworth."— Presentation transcript:

1 Headaches - In Primary Care Dr M Banerjee GP Registrar Tadworth

2 Main Types Tension Headache Migraine Cluster Headache OR Secondary to underlying cause

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

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

5 Secondary Headaches Intracranial lesion Meningitis Subarachnoid haemorrhage Acute close angle glaucoma Temporal arteritis

6 Red flag signs Increased ICP Focal neurological signs Constitutional signs Intensity- “worst headache of my life” Head injury New onset – age > 50 yrs

7 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

8 Migraine Visual aura -> throbbing Episodic severe Photophobia, nausea,vomiting Precipitating factors Symptom diaries

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

10 Cluster- management 100% O2 Ergotamine or triptan nasal spray Intranasal lidocaine Verapamil – prophylaxis May need neurologist referral

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

12 Tension - management Reassure NSAIDS – avoid opioids Lifestyle modifications

13 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

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