Diagnosis and treatment of headaches

Headaches are one of the most common problems seen in a GP surgery. They can be very painful and sometimes debilitating. However, most often they are not dangerous.

Seeing a GP and giving them as much information as possible about your headaches will support an accurate diagnosis and treatment plan for you. Keeping a headache journal puts your GP in the best position to offer advice and information to meet your individual needs.

In this article we discuss when you should see a doctor about your headaches and what to expect at your appointment, why it’s important to get an accurate diagnosis, and your treatment options.

Fitzwilliam’s private GP, Dr Hutchinson, offers expert and timely advice and treatment to our headache patients. 


When to see a GP about your headache

If you are experiencing frequent or severe headaches, you should see your GP. If painkillers do not seem to be working and/or you feel or are sick and you find light or noise painful, you should also book to see a GP.

You may have a migraine or more rarely a cluster headache if you have throbbing pain at the front or side of your head. Again, go and see your GP about this.


Types of headaches

Not all headaches are the same. By correctly identifying the type of headache you have and its root cause, your GP can give appropriate treatment to alleviate your headache symptoms.  

Primary headaches are the most common type of headaches.  They are ‘primary’  as they are a stand alone headache rather than being a symptom of an underlying disease or condition in which case they would be considered a ‘secondary headache’.  Serious causes for secondary headaches are uncommon and brain tumours being the cause of a headache is quite rare. 

Primary headaches include migraines, tension-type headaches (TTH), and cluster headaches (CH).  These have very different triggers and associations and very different treatment plans.


What type of headache is most common?

According to the British Association for the Study of Headaches (BASH), the most common headaches are tension headaches and migraines.

About 12% of the population suffers from migraine headaches. A migraine is the most disabling headache whereas a tension headache typically causes relatively little disability1This does not mean that tension headaches are   only a minor inconvenience but rather people can typically muddle on with their day  rather than being very unwell and bed bound which can often be the case for someone experiencing a migraine headache.

Most other headache disorders are much less common.


What to expect when you see a GP about a headache

Your GP will evaluate you and your headache by:

·       conducting a physical and neurological exam

·       discussing your medical history

·       finding out about your headache symptoms and how often they happen, their severity and impact, and their location

·       understanding anything that may trigger a headache

·       any medications you currently use.

You should try to give your doctor as much information as possible. Include any triggers that may be causing your headaches or things that make them worse. Also, talk about what helps you feel better.

A headache diary can be useful to help your doctor diagnose your headache. It can identify patterns and triggers of your headache.


Will I need diagnostic tests to find out the cause of my headache?

Most people don’t need diagnostic tests to find out the cause of their headaches. They are generally not needed to diagnose a primary headache.

However, diagnostic scans can be useful to help diagnose some secondary headache pain. For example, CT and MRI scans produce cross-sectional images of your brain and can help determine if your headaches are connected to a central nervous system issue.

Many patients with longstanding headaches would like the reassurance of a brain scan. However, if you have no other signs and symptoms apart from a headache, known as isolated headaches, it is rare to have an underlying sinister cause for your headache and brain imaging would not be warranted.  There is no significant increase in abnormal scans in people with or without isolated longstanding headaches.


The importance of diagnosing headaches correctly

It’s important to diagnose headaches correctly so that you receive the right treatment for your specific type of headache.

For primary headaches, headache trigger trackers and headache diaries can be effective tools to help diagnose the cause of your headaches.


When to seek headache specialist advice?

Most often, a GP will refer you to a headache specialist if your headache symptoms get worse or more frequent despite treatment or if it's not clear what's causing them.

BASH says that “if you have restricted your pain killer use to less than 2 days a week and tried at least two preventatives – your GP can make a referral enclosing copies of your headache diaries and a summary of preventative medication, otherwise, the advice is likely to be to: keep a daily headache diary for at least three months

don’t take painkillers too often. “Taking painkillers on more than 2 days per week can cause a medication overuse headache. Headaches improve in about 70% of people once pain killers are reduced and adequate preventative treatment established.”1


Can I prevent headaches?

Yes, headaches are preventable if you know what triggers them and you avoid or minimise the trigger. Triggers are very specific to each person. You need to figure out what triggers your headache.  

Common triggers include lack of sleep, stress, poor posture, strong scents, bright lights, and troublesome foods.  Often people will need  exposure to several of their triggers within a time frame for the headache to develop and this is why sometimes it can be tricky understanding what your personal triggers might be as each thing in isolation can be  well tolerated. 


How are headaches treated?

Your GP will make a treatment plan to meet your specific headache type, frequency, and cause. Treatments can include:

medications – these may be over-the-counter pain relievers or prescription medications.

acupuncture – is thought to stimulate the production of naturally occurring pain-relieving substances. Needle movement during treatment also suppresses pain transmission.

stress management - teaches coping strategies for stressful situations such as relaxation techniques.

counselling – helps to identify and manage emotional/psychological influences that may be triggering or exacerbating your headache.

electronic medical devices – deliver low-level electric current to block pain signals of headaches.

biofeedback – uses body sensors to monitor involuntary physical responses to headaches such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. It teaches you to recognise when you are becoming tense and situations you find stressful and then offers ways to relieve this.

treating the underlying medical cause.


Tension-type headache treatment

Over-the-counter painkillers, such as paracetamol and ibuprofen, are often taken as tension headache treatments. If you have a headache two to three times a week or more, your GP may prescribe more effective prophylactic treatment as  having a reliance on pain relief medication regularly can cause a phenomenon known as medication overuse headache.

Biofeedback, counselling and stress management may also be useful.


Migraine treatment

There is no migraine cure as such but migraine treatments and  the understanding we now have about migraines has progressed enormously in recent years including  exciting developments in treatments for chronic migraine that have received approval from NICE.

Many migraine sufferers may find resting in a dark, quiet room is helpful.  This isn’t always practical and so there are a variety of other strategies that can be adopted in support of self care and alleviating suffering.  The more informed you are on your headache journey the more empowered you can feel to regain control.

Migraine treatments include:

painkillers such as ibuprofen and paracetamol

specialised migraine pain killers called triptans available as tablets, injections, and nasal sprays

anti-sickness medicines.

You may need to make lifestyle changes to help manage your migraines, such as regular eating times and reducing caffeine.

Learning relaxation techniques, acupuncture, and nerve stimulation devices may also be recommended to help treat migraines.

Gepant is a new medication to treat acute migraine. It may be suitable for migraine sufferers who do not respond to triptans or have side effects.


Cluster headache treatment

Treatments for a cluster headache that has already started include:

medicines called triptans as an injection or a nasal spray

oxygen therapy where you breathe pure oxygen through a mask

electronic medical device used at the back of your neck

other preventive medications.


Fitzwilliam Hospitals’ Private GP Service

If you have headaches that are interfering with your daily functioning or affecting your mood, you should book an appointment with a GP.

Our private GP service offers you timely and convenient appointments without waiting. You will have the opportunity to discuss all your concerns in a relaxed and unrushed appointment. You can immediately take away private prescriptions and have direct access to diagnostic tests should they be needed.


Meet Dr Donna Hutchinson, a Private GP at Fitzwilliam with a special interest in headache diagnosis

Dr Donna Hutchinson is passionate about providing a patient-centred focus on care and empowering patients to take responsibility for their health.

She has been a member of the Migraine World Summit since 2016 and offers patients a full spectrum of headache management treatments. These include both conventional and recognised alternative/complimentary headache treatment strategies. She works with her patients to find a treatment that is just right for them and the type of headache they are experiencing.

Firstly, Dr Hutchinson will categorise the type of headache you are experiencing.  If your primary diagnosis is uncertain but a secondary cause has been excluded, she will recommend keeping a headache diary and/or quality of life assessment tool to measure the frequency, duration, severity, triggers, medications used, and impact of your headaches for at least 8 weeks.

Dr Hutchinson follows the BASH guidelines (British Association for the Study of Headache) for headache evaluation and diagnostics and the NICE guidelines for treatment protocols.


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1 https://bash.org.uk/headache-sufferers/