Scottish Intercollegiate Guidelines Network (SIGN)

SIGN 107: DIAGNOSIS AND MANAGEMENT OF
HEADACHE IN ADULTS

BACKGROUND

Headache is common, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations.

Headache disorders are classified as primary or secondary. Primary headache disorders (those not associated with underlying pathology) include migraine, tension-type headache and cluster headache.

Secondary headache disorders have an identifiable structural, infective or biochemical cause, eg subarachnoid blood, bacterial meningitis, brain tumour, medication overuse. Migraine and tension-type headache are the most common forms of primary headache in the UK.

WHY WE NEED A GUIDELINE

Healthcare professionals often find the diagnosis of headache difficult and both healthcare professionals and patients worry about serious rare causes of headaches such as brain tumours.

General practitioners are often uncertain about when to refer patients to secondary care. Most patients with primary headache can be managed in primary care and investigations are rarely needed. There are many effective therapies, but overuse of treatments can also cause headache.

THE CHALLENGE FOR HEALTHCARE PRACTITIONERS

…is to correctly diagnose headache so that the patient can be managed appropriately in primary care, or, when necessary, referred to secondary care or a headache clinic.

As there are a range of treatments patients need to be monitored to ensure they receive the most effective therapy.

REMIT

This guideline provides recommendations based on current evidence for best practice in the diagnosis and management of headache in adults.
It focuses on the more common primary headaches and addresses some of the rarer primary headaches which have recognisable features with specific treatments.

Secondary headache due to medication overuse is addressed, as the overuse of headache medication can compromise the management of primary headache. “Red flags” for secondary headache are also highlighted.
It provides discussion and recommendations on:

signs, symptoms and definitions of common headache types
tools to aid diagnosis of headache
investigations for headache
treatment therapies for the acute and prophylactic management of migraine, tension-type headache and trigeminal autonomic cephalalgias
assessment and treatment of medication overuse headache
headache associated with pregnancy, contraception, menstruation and the menopause
prophylaxis through lifestyle factors, such as diet modification and trigger avoidance, psychological, physical and complementary therapies.

POTENTIAL USERS

The guideline will be of interest to general practitioners, community pharmacists, opticians, dental practitioners, and healthcare professionals with an interest in neurology or headache.