Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2002 Jul;52(480):569–573.

Headache in primary care: how important is diagnosis to management?

Norma O'Flynn 1, Leone Ridsdale 1
PMCID: PMC1314361  PMID: 12120731

Abstract

Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evidence from other settings is considered and gaps in the literature highlighted.

Full Text

The Full Text of this article is available as a PDF (95.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Banks M. H., Beresford S. A., Morrell D. C., Waller J. J., Watkins C. J. Factors influencing demand for primary medical care in women aged 20-44 years: a preliminary report. Int J Epidemiol. 1975 Sep;4(3):189–195. doi: 10.1093/ije/4.3.189. [DOI] [PubMed] [Google Scholar]
  2. Bendtsen L., Jensen R., Olesen J. A non-selective (amitriptyline), but not a selective (citalopram), serotonin reuptake inhibitor is effective in the prophylactic treatment of chronic tension-type headache. J Neurol Neurosurg Psychiatry. 1996 Sep;61(3):285–290. doi: 10.1136/jnnp.61.3.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bove G., Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA. 1998 Nov 11;280(18):1576–1579. doi: 10.1001/jama.280.18.1576. [DOI] [PubMed] [Google Scholar]
  4. Bánk J. A comparative study of amitriptyline and fluvoxamine in migraine prophylaxis. Headache. 1994 Sep;34(8):476–478. doi: 10.1111/j.1526-4610.1994.hed3408476.x. [DOI] [PubMed] [Google Scholar]
  5. Castillo J., Muñoz P., Guitera V., Pascual J. Kaplan Award 1998. Epidemiology of chronic daily headache in the general population. Headache. 1999 Mar;39(3):190–196. doi: 10.1046/j.1526-4610.1999.3903190.x. [DOI] [PubMed] [Google Scholar]
  6. Fitzpatrick R. M., Hopkins A. P., Harvard-Watts O. Social dimensions of healing: a longitudinal study of outcomes of medical management of headaches. Soc Sci Med. 1983;17(8):501–510. doi: 10.1016/0277-9536(83)90057-6. [DOI] [PubMed] [Google Scholar]
  7. Fitzpatrick R., Hopkins A. Referrals to neurologists for headaches not due to structural disease. J Neurol Neurosurg Psychiatry. 1981 Dec;44(12):1061–1067. doi: 10.1136/jnnp.44.12.1061. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Forward S. P., McGrath P. J., MacKinnon D., Brown T. L., Swann J., Currie E. L. Medication patterns of recurrent headache sufferers: a community study. Cephalalgia. 1998 Apr;18(3):146–151. doi: 10.1046/j.1468-2982.1998.1803146.x. [DOI] [PubMed] [Google Scholar]
  9. Goadsby P. J., Olesen J. Diagnosis and management of migraine. BMJ. 1996 May 18;312(7041):1279–1283. doi: 10.1136/bmj.312.7041.1279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Haynes R. B., Sackett D. L., Taylor D. W., Gibson E. S., Johnson A. L. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med. 1978 Oct 5;299(14):741–744. doi: 10.1056/NEJM197810052991403. [DOI] [PubMed] [Google Scholar]
  11. Karachalios G. N., Fotiadou A., Chrisikos N., Karabetsos A., Kehagioglou K. Treatment of acute migraine attack with diclofenac sodium: a double-blind study. Headache. 1992 Feb;32(2):98–100. doi: 10.1111/j.1526-4610.1992.hed3202098.x. [DOI] [PubMed] [Google Scholar]
  12. Kloster R., Nestvold K., Vilming S. T. A double-blind study of ibuprofen versus placebo in the treatment of acute migraine attacks. Cephalalgia. 1992 Jun;12(3):169–128. doi: 10.1046/j.1468-2982.1992.1203169.x. [DOI] [PubMed] [Google Scholar]
  13. Limmroth V., Katsarava Z., Diener H. C. Acetylsalicylic acid in the treatment of headache. Cephalalgia. 1999 Jul;19(6):545–551. doi: 10.1046/j.1468-2982.1999.019006545.x. [DOI] [PubMed] [Google Scholar]
  14. Lipton R. B., Stewart W. F., von Korff M. Burden of migraine: societal costs and therapeutic opportunities. Neurology. 1997 Mar;48(3 Suppl 3):S4–S9. doi: 10.1212/wnl.48.3_suppl_3.4s. [DOI] [PubMed] [Google Scholar]
  15. Lydeard S., Jones R. Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters. J R Coll Gen Pract. 1989 Dec;39(329):495–498. [PMC free article] [PubMed] [Google Scholar]
  16. Nappi G., Agnoli A., Manzoni G. C., Nattero G., Sicuteri F. Classification and diagnostic criteria for primary headache disorders (Ad Hoc Committee IHS, 1988). Funct Neurol. 1989 Jan-Mar;4(1):65–71. [PubMed] [Google Scholar]
  17. Nebe J., Heier M., Diener H. C. Low-dose ibuprofen in self-medication of mild to moderate headache: a comparison with acetylsalicylic acid and placebo. Cephalalgia. 1995 Dec;15(6):531–535. doi: 10.1046/j.1468-2982.1995.1506531.x. [DOI] [PubMed] [Google Scholar]
  18. Nilsson N., Christensen H. W., Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther. 1997 Jun;20(5):326–330. [PubMed] [Google Scholar]
  19. O'Quinn S., Davis R. L., Gutterman D. L., Pait G. D., Fox A. W. Prospective large-scale study of the tolerability of subcutaneous sumatriptan injection for acute treatment of migraine. Cephalalgia. 1999 May;19(4):223–200. doi: 10.1046/j.1468-2982.1999.019004223.x. [DOI] [PubMed] [Google Scholar]
  20. Olesen J. The International Headache Society classification and diagnostic criteria are valid and extremely useful. Cephalalgia. 1996 Aug;16(5):293–296. doi: 10.1046/j.1468-2982.1996.1605294.x. [DOI] [PubMed] [Google Scholar]
  21. Oxman A. D., Sackett D. L., Guyatt G. H. Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA. 1993 Nov 3;270(17):2093–2095. [PubMed] [Google Scholar]
  22. Pearce J. M. Are the International Headache Society criteria for headache useful? Cephalalgia. 1996 Aug;16(5):289–296. doi: 10.1046/j.1468-2982.1996.1605289.x. [DOI] [PubMed] [Google Scholar]
  23. Peatfield R. C., Petty R. G., Rose F. C. Double blind comparison of mefenamic acid and acetaminophen (paracetamol) in migraine. Cephalalgia. 1983 Jun;3(2):129–134. doi: 10.1046/j.1468-2982.1983.0302129.x. [DOI] [PubMed] [Google Scholar]
  24. Pryse-Phillips W. E., Dodick D. W., Edmeads J. G., Gawel M. J., Nelson R. F., Purdy R. A., Robinson G., Stirling D., Worthington I. Guidelines for the diagnosis and management of migraine in clinical practice. Canadian Headache Society. CMAJ. 1997 May 1;156(9):1273–1287. [PMC free article] [PubMed] [Google Scholar]
  25. Rasmussen B. K. Epidemiology of headache. Cephalalgia. 1995 Feb;15(1):45–68. doi: 10.1046/j.1468-2982.1995.1501045.x. [DOI] [PubMed] [Google Scholar]
  26. Rasmussen B. K., Jensen R., Schroll M., Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991;44(11):1147–1157. doi: 10.1016/0895-4356(91)90147-2. [DOI] [PubMed] [Google Scholar]
  27. Reynolds G. A., Chitnis J. G., Roland M. O. General practitioner outpatient referrals: do good doctors refer more patients to hospital? BMJ. 1991 May 25;302(6787):1250–1252. doi: 10.1136/bmj.302.6787.1250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Russell M. B., Rasmussen B. K., Brennum J., Iversen H. K., Jensen R. A., Olesen J. Presentation of a new instrument: the diagnostic headache diary. Cephalalgia. 1992 Dec;12(6):369–374. doi: 10.1111/j.1468-2982.1992.00369.x. [DOI] [PubMed] [Google Scholar]
  29. Salander P., Bergenheim A. T., Hamberg K., Henriksson R. Pathways from symptoms to medical care: a descriptive study of symptom development and obstacles to early diagnosis in brain tumour patients. Fam Pract. 1999 Apr;16(2):143–148. doi: 10.1093/fampra/16.2.143. [DOI] [PubMed] [Google Scholar]
  30. Schachtel B. P., Furey S. A., Thoden W. R. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol. 1996 Dec;36(12):1120–1125. doi: 10.1002/j.1552-4604.1996.tb04165.x. [DOI] [PubMed] [Google Scholar]
  31. Scharff L., Turk D. C., Marcus D. A. Psychosocial and behavioral characteristics in chronic headache patients: support for a continuum and dual-diagnostic approach. Cephalalgia. 1995 Jun;15(3):216–223. doi: 10.1046/j.1468-2982.1995.015003216.x. [DOI] [PubMed] [Google Scholar]
  32. Scher A. I., Stewart W. F., Liberman J., Lipton R. B. Prevalence of frequent headache in a population sample. Headache. 1998 Jul-Aug;38(7):497–506. doi: 10.1046/j.1526-4610.1998.3807497.x. [DOI] [PubMed] [Google Scholar]
  33. Stang P. E., Von Korff M. The diagnosis of headache in primary care: factors in the agreement of clinical and standardized diagnoses. Headache. 1994 Mar;34(3):138–142. doi: 10.1111/j.1526-4610.1994.hed3403138.x. [DOI] [PubMed] [Google Scholar]
  34. Starfield B. Is primary care essential? Lancet. 1994 Oct 22;344(8930):1129–1133. doi: 10.1016/s0140-6736(94)90634-3. [DOI] [PubMed] [Google Scholar]
  35. Steiner T. J., Lange R. Ketoprofen (25 mg) in the symptomatic treatment of episodic tension-type headache: double-blind placebo-controlled comparison with acetaminophen (1000 mg). Cephalalgia. 1998 Jan;18(1):38–43. doi: 10.1046/j.1468-2982.1998.1801038.x. [DOI] [PubMed] [Google Scholar]
  36. Tfelt-Hansen P. Efficacy and adverse events of subcutaneous, oral, and intranasal sumatriptan used for migraine treatment: a systematic review based on number needed to treat. Cephalalgia. 1998 Oct;18(8):532–538. doi: 10.1046/j.1468-2982.1998.1808532.x. [DOI] [PubMed] [Google Scholar]
  37. Tfelt-Hansen P., Henry P., Mulder L. J., Scheldewaert R. G., Schoenen J., Chazot G. The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet. 1995 Oct 7;346(8980):923–926. doi: 10.1016/s0140-6736(95)91554-0. [DOI] [PubMed] [Google Scholar]
  38. Treves T. A., Streiffler M., Korczyn A. D. Naproxen sodium versus ergotamine tartrate in the treatment of acute migraine attacks. Headache. 1992 Jun;32(6):280–282. doi: 10.1111/j.1526-4610.1992.hed3206280.x. [DOI] [PubMed] [Google Scholar]
  39. Von Korff M., Black L. K., Saunders K., Galer B. S. Headache medication-use among primary care headache patients in a health maintenance organization. Cephalalgia. 1999 Jul;19(6):575–542. doi: 10.1046/j.1468-2982.1999.019006575.x. [DOI] [PubMed] [Google Scholar]
  40. Wiles C. M., Lindsay M. General practice referrals to a department of neurology. J R Coll Physicians Lond. 1996 Sep-Oct;30(5):426–431. [PMC free article] [PubMed] [Google Scholar]
  41. Wilkin D., Smith A. Explaining variation in general practitioner referrals to hospital. Fam Pract. 1987 Sep;4(3):160–169. doi: 10.1093/fampra/4.3.160. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES