Headache

INTRODUCTION

The commonest cause of headache presenting in general practice is respiratory infection. Common causes of chronic recurrent headache are tension, so-called transformed migraine and combination (mixed) headaches. Migraine is not as common as in specialist practice.

TENSION-TYPE HEADACHE

Tension or muscle contraction headaches typically have bilateral tightness or aching. They can be episodic or chronic. They tend to last for hours and recur each day. They are often associated with cervical dysfunction and stress or tension, although the patient may be unaware of such tension (see Fig. H3).

Management

• Careful patient education

• Counselling and reassurance

• Advise stress reduction, relaxation therapy and yoga or meditation classes; provide mindfulness therapy or CBT

• Medication—mild analgesics such as aspirin or paracetamol; avoid tranquillisers and antidepressants if possible but consider these drugs if symptoms warrant medication (e.g. amitriptyline 10 mg (o) nocte increasing to 75 mg if nec.)

MIGRAINE

Migraine, or the ‘sick headache’, is derived from the Greek word meaning ‘pain involving half the head’. It affects at least 1 person in 10, ratio : ~2:1, and peaks between 20–50 yrs. There are various types of migraine with classic migraine (headache, vomiting and aura) and common migraine (without the aura) being the best known.

Management Patient education—explanation and reassurance about the benign nature of migraine

Counselling and advice

• Avoid known trigger factors, e.g. physical or emotional stress, lack of sleep, bright lights

• Diet: keep a diary—consider elimination of chocolate, cheese, red wine, walnuts, tuna, Vegemite, spinach and liver

• Practise a healthy lifestyle, relaxation programs, meditation ...