Warning

Some tips before referral:

  1. CT head? Do you want a clinical opinion or a CT head scan? – if just the latter then NHS D&G provides open access CT head. Remember, incidental finding (10%) vs. relevant finding (<0.5%), radiation dose is over 100 chest x-rays and studies suggest it doesn’t provide long-lasting reassurance
  2. Acute treatments for migraine – have you tried soluble Aspirin 900mg, Sumatriptan 100mg, Almotriptan 12.5mg, rizatriptan 10mg with anti-emetics? If severe vomiting, try subcutaneous Sumatriptan 6mg.
  3. Preventative treatment for migraine (see below links for more detail) – have you tried a Beta-blocker (eg Propanolol), Antiepileptic (Topiramate) or Tricyclic (eg Amitriptyline) at therapeutic doses for 3-4 months each.
  4. Treatment of medication overuse headache – Stop regular analgesia (especially codeine) and limit acute treatment to 10x/month. Tell the patient they will feel worse for a while and wait for 3-4 weeks before expecting any benefit
  5. Tackle insomnia and fatigue – Many patients with chronic daily headache also have insomnia and fatigue. Improving other causes of these symptoms can improve headache.+

Guide to differentiating headache

Editorial Information

Next review date: 15/07/2023

Author(s): Ondrej Dolezal.