INTRODUCTION
NICE has developed guidelines on management of primary headache disorders in young people and adults.1 The guideline is intended for non-specialist use, particularly for use in primary care where the majority of headaches can be safely diagnosed and managed. Four per cent of adults have a primary care consultation for headache per year2 but GPs lack confidence in the diagnosis and management of primary headache disorders, and can be anxious about missing serious secondary causes.3 Improved recognition of the common headache disorders and better targeting of available treatments should reduce the burden of headache without requiring substantial additional resources. If specialist advice is required the guideline recommends that this can be via a neurologist or GP with a special interest in headache.
THE GUIDANCE
The guideline lists signs, symptoms, and possible conditions that should be considered before proceeding to a diagnosis of a primary headache disorder (Box 1).
Box 1. Signs and symptoms to suggest possibility of secondary headache
Worsening headache with fever
Thunderclap headache
New-onset neurological deficit
New-onset cognitive dysfunction
Change in personality
Impaired level of consciousness
Head trauma in previous 3 months
Headache triggered by cough, vasalva, or sneeze
Headache triggered by exercise
Headache that changes with posture
Clinical features of giant cell arteritis
Clinical features of glaucoma
Significant change in characteristics of headache
Atypical aura
Caution should be exercised if patients have a history of malignancy, particularly if they are aged <20 years, or have had cancer that may metastasise to the brain. The possibility of central nervous system infection in immunocompromised patients or of HIV-associated neurological disease should be considered where appropriate.
The guideline includes recommendations on medication-overuse headache. This is headache that has developed or worsened after taking acute treatments for headache regularly for ≥3 months. It is thought that using triptans, …