HNY Policy and Pathway Repository - Humber

A headache management education programme aimed at assisting GP’s in the management of patients aged over 12 with primary headache disorders. The programme will be led and delivered by the Headache Specialist Nurse.

Headache disorders are classified as primary or secondary. Primary headaches are classified according to their clinical pattern. 

Secondary headaches are attributed to underlying disorders and include headaches associated with medication overuse, giant cell arteritis, raised intracranial pressure and infection.  Medication overuse headache most commonly occur in those taking medication for a primary headache disorder. 

The programme will provide GP’s with an alternative to secondary care referral via the 18 week pathway.

Referrals will be accepted for:

• Migraine
• Cluster Headache
• Tension Headache
• Medication overuse headache
• Undiagnosed Chronic Headaches (No Red Flags)

Exclude Red Flag Symptoms

The programme will not diagnose individual patients.

If a patient discloses a ‘Red Flag’ during their attendance, something which requires referral to secondary care or more urgent attention, the patient will be informed and advised to see their own doctor and their GP will be informed directly.

The programme will be delivered as a weekly group session and led by the Headache Specialist Nurse. The Sessions will cover:

• Overview of common primary headaches
• When to worry / when to see your GP
• Overview of available treatments
• Diet and lifestyle
• Relaxation exercises
• Medication overuse and detoxification
• Assessment tools and headache diaries
• Complete Headache Questionnaire HIT-6
• Summarise headache diary
• Patient role in own care and headache management
• Information healthcare professionals require to make a diagnosis
• Managing expectations of healthcare and treatments

Patient returns to GP Surgery after 6 weeks where the Headtake diagnosis can then be confirmed and GP can implement management plan as per NICE guidance on Headaches.

If Medication overuse identified, plan detoxification then reassess with further headache diaries 6 weeks post detoxification.

If a primary headache diagnosis is made manage as per NICE guidelines. 

If Chronic Migraine is identified and patient fulfils NICE criteria for treatment with Botox consider referral straight to Chronic Migraine Service offering Botox.

If diagnosis remains unclear GP should consider referral to Headache Service, Hull and East Yorkshire Hospitals NHS Trust and ask patient to continue to maintain headache diaries.

NICE clinical guideline 150 lists the signs and symptoms of secondary headaches for which further investigations and/or referral to Neurology / Headache Specialist may be considered:

• Worsening headache with fever
• Sudden-onset headache reaching maximum intensity within 5 minutes
• New-onset neurological defect
• New-onset cognitive dysfunction
• Change in personality
• Impaired level of consciousness
• Recent (typically within the past 3 months) head trauma
• Headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked) or sneeze
• Headache triggered by exercise
• Orthostatic headache (headaches that change with posture)
• Symptoms suggestive of giant cell arteritis
• Symptoms and signs of acute narrow-angle glaucoma
• Asubstantial change in characteristics of their headache.

NICE clinical guideline 150 also states criteria for which further investigations and/or referral may be considered for people who present with new-onset headache. These are:

• Compromised immunity, caused, for example, by HIV or immunosuppressive drugs
• Age under 20 years and a history of malignancy
• A history of malignancy known to metastasise to the brain
• Vomiting without other obvious cause (for example a migraine attack).

Headache Management Education Programme

NICE guidelines for Primary Headache Diagnosis

NICE criteria for treatment with Botox

Directory of Service for Headache Disorders