Headache

Peter Goadsby recently reviewed headache in the BMJ, see "Recent advances in the diagnosis and management of migraine BMJ, Jan 2006; 332: 25 - 29".

There was lots of information in their for the GP and as it's a review and summary I took away some messages.

Migraine - worth diagnosing because there are some effective treatments. Diagnosis relies on:
Repeated headache lasting 4-72 hours, normal physical examination, no other reasonable cause for the headache, at least two of

• Unilateral pain
• Throbbing pain
• Aggravation of pain by movement
• Moderate or severe intensity of pain with at least one of
• Nausea or vomiting
• Photophobia and phonophobia

Secondary Headache is the one that worries us GP's. Are we missing a sinister cause? Warning signs for secondary headache include:

• Pain of sudden onset
• Fever
• Marked change in pain character or timing
• Neck stiffness
• Pain associated with higher centre complaints
• Pain associatedwith neurological disturbance, such as clumsiness or weakness
• Pain associated with local tenderness, such as of the temporal artery

The article also considers the pathophysiology of migraine, treatments and differentiating different sorts of headache.