Headaches are an extremely common disorder and approximately half the population experience them at one time or another. The vast majority require no special investigations and can be diagnosed and effectively treated by the General Practitioner. These headaches are called primary headache disorders and over 90% of these headaches are due to two causes – migraine or tension type headache (TTH).
Only a small proportion of headaches require specialist input and these are termed secondary headaches. These can be more serious but there are specific “red flag” symptoms that can be used to identify them. Secondary headaches need prompt attention or referral to hospital.
This brief article provides an overview of the commonest headache types – the primary headaches – and how these are best managed. It also discusses red flag symptoms which may need input from a specialist in the hospital.
Primary Headache Disorders
Primary headache disorders are common. The World Health Authority includes headaches among the top ten causes of disability worldwide, and primary headache disorders are as common as asthma or diabetes.
Primary headache disorders include several different conditions, notably Tension Type Headaches and Migraine. There are some other less common causes such as cluster headaches, and we are preparing some web pages on these.
Red Flags and headaches
The overwhelming proportion of headaches do not have any more serious underlying cause. Doctors keep in mind a number of red flag symptoms when assessing patients' headaches. Headaches due to underlying causes are called secondary headaches. A doctor should be made aware if any of these occur. It should be borne in mind that serious causes for headaches are very rare and the list below is supplied as a guide only.
Potential “red flag” warning features:
- A new or unexpected headache
- A thunderclap headache or a headache which is very intense or “explosive”
- Headache with persistent weakness (>1hour)
- A headache occurring for the first time when the contraceptive pill is started
- A new onset headache in a patient older than 50 years or younger than 10 years
- Persistent headaches in the morning with associated nausea
- Progressively worse headaches over weeks
- Headaches associated with unsteadiness
- New headaches in a patient with a history of cancer or HIV infection
Headache is one of the most common symptoms in the general population. Migraine and tension type headaches account for the vast majority. These can be easily managed in the community with the help of general practitioners. Headache treatment does need an individualized approach and there may be circumstances that warrant more specialist input.
see the Map of Medicine pathway for Headache here.
The Scottish Intercollegiate Guidelines Network (SIGN) have published a very detailed guideline document on headache.
NHS Choices information page on headache
British Association for the Study of Headache (BASH), www.bash.org.uk
Individual headache Links
Cluster headaches - patient.co.uk site
Migraine - patient.co.uk site
The Migraine Trust, www.migrainetrust.org
This site complies with the HONcode standard for trustworthy health information:
Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 15/02/2016