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Headache: new guidelines advise doctors on assessment and treatment

Up to 1 in 50 people have headaches which are caused by taking too many painkillers, while patients with other types of headache do not always get a correct diagnosis straight away.

That's according to the National Institute of Clinical Excellence (NICE), which has just issued new guidelines on assessing and treating headache to help combat these problems.

NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and the treatments they should receive. The information applies to people using the NHS in England and Wales.

The new guidelines apply to people aged 12 and over who are having problems with headaches.

Types of headaches

The guidelines apply to 3 types of primary headache (headaches that do not have an underlying cause):

  • Tension-type headache
  • Migraine, including migraine with aura and menstrual related migraine
  • Cluster headache

They also address a common type of secondary headache, medication overuse headache. According to NICE, up to 1 in 50 people experience headaches caused by medication overuse. They occur when people take painkillers or triptan drugs too often for tension-type ("every day") headaches or migraine attacks. Doing this can reduce their effectiveness and cause further pain.

What to expect

Dr Gillian Leng, Deputy Chief Executive of NICE said: "Although headache is the most common neurological problem seen by GPs and neurologists, many people are not receiving correct or timely diagnoses. The key features of medication overuse and the symptoms that distinguish the types of primary headache can be overlooked and concerns from patients about possible underlying causes can lead to unnecessary hospital investigations. These can mean people experience delays in receiving adequate pain relief from what can be an extremely disabling condition.

"Our guideline outlines the assessments and treatments that people should expect to receive for primary headaches and medication overuse. We hope that this will help GPs and other healthcare professionals to correctly diagnose the type of headache disorder and better recognise patients whose headaches could be caused by their over-reliance on medications."

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