Problem of over-using headache medicine highlighted in new guideline

Headache diaries can aid diagnosis and management of headache

A new guideline just published highlights the problem of over-medication in the treatment and development of chronic headache. Overuse of all acute headache treatments can themselves cause headache, known as ‘medication overuse headache’. The problem is most apparent in opioid-containing analgesics, yet can also appear with simple and combination analgesics. Stopping the overused medication usually results in improvement in headache frequency and severity. The guideline recommends that the risks of patients developing headache as a result of overuse should be discussed with all patients when initiating acute treatment.

The new guideline from the Scottish Intercollegiate Guidelines Network (SIGN) - part of NHS Quality Improvement Scotland (NHS QIS) – will be of interest to general practitioners, community pharmacists, opticians, dental practitioners, and healthcare professionals with an interest in neurology or headache.

Headache is common, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations.

Healthcare professionals often find the diagnosis of headache difficult and both healthcare professionals and patients worry about serious rare causes of headaches such as brain tumours. General practitioners are often uncertain about when to refer patients to secondary care and this guideline seeks to improve their understanding and aid their decision-making. The guideline emphasises that most patients with primary headache can be managed in primary care and investigations are rarely needed.

The guideline also emphasises that diagnosis can be aided by patients keeping a diary that records their experiences with headache. Patients, primary care clinicians and headache specialists commonly get the diagnosis wrong and this may be because of limited consultation time or poor patient recall. Clinician review and analysis of a diary that records headache symptoms over a few weeks and the use of appropriate assessment questionnaires can improve diagnosis and lead to more effective management.

The guideline contains information on the following:

tools to aid diagnosis of headache
treatment therapies for the acute and prophylactic management of migraine, tension-type headache and trigeminal autonomic cephalalgias
assessment and treatment of ‘medication overuse headache’
issues around headache associated with pregnancy, contraception, menstruation and the menopause
prophylaxis through lifestyle factors, such as diet modification and trigger avoidance, psychological, physical and complementary therapies.

Speaking of the guideline, Dr David PB Watson GP, chair of the guideline development group, and a GP in Aberdeen, said: “People often don’t attend their GP for headache because they believe that treatments for headache are not very effective. As this guideline highlights, this is not the case. In fact, correct management of headaches can lead to real improvements for patients and this guideline brings together the best available evidence in order to aid diagnosis and treatment.”

Editors Note:

Trigeminal autonomic cephalalgias – A type of headache of which cluster headache is an example, and characterised by severe recurrent short lasting headaches, often located through or around either eye.
SIGN develops national clinical guidelines aimed at reducing variations in clinical practice and in outcomes for patients. Founded in 1993, SIGN became part of the national clinical effectiveness body, NHS Quality Improvement Scotland, on 1 January 2005.
NHS Quality Improvement Scotland has been established to lead in improving the quality of care and treatment delivered by NHSScotland. To do this it sets standards and monitors performance, and provides NHSScotland with advice, guidance and support on effective clinical practice and service improvements.
The SIGN guideline, ‘Diagnosis and management of headache in adults - A national clinical guideline’, is available from www.sign.ac.uk.

Media Contact: Stephen Ferguson on 07779 329 689