NICE seeks views on draft headaches guideline

People who experience headaches and migraines might not be receiving correct and timely diagnoses from their GPs or other healthcare professionals. The healthcare guidance body, NICE has developed draft recommendations for the NHS on the diagnosis and management of primary headaches in adults and young people (i.e. those aged over 12 years). These have been published today (Wednesday 25 April) as part of a public consultation.

More than 10 million people in the UK experience headaches, making headaches one of the most common health complaints. For the first time, guidance will soon be available for GPs and other generalist doctors on how they should diagnose the three most common types of primary headache (i.e. those that are not caused by underlying health concerns). These are tension-type headache, migraine and cluster headaches. This advice will include the exact location of the pain, its intensity, duration, frequency and other symptoms to look out for.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: "Despite headaches being the most common neurological problem presented to GPs and neurologists, many people who experience them aren't receiving accurate or timely diagnoses. Also, concerns about the possible underlying causes need to be appropriately managed in order to avoid unnecessary investigations, which can in turn lead to delays in people receiving adequate pain relief, for what can be an extremely disabling condition.

"Once published, we hope our guidance will support healthcare professionals in recognising and diagnosing the most common types of primary headache and reassure their patients that other possible causes have been excluded."

Draft recommendations include:

  • Include the following in discussions with people who have a headache disorder:

    - A positive diagnosis and reassurance that other pathology has been excluded

    - The options for management

    - Recognition that headache is a valid medical disorder that has a significant impact on the person and their family.
  • Be aware of the possibility of medication overuse being the underlying cause of headache in people whose headaches developed or worsened while taking the following drugs for three or more months:

    - triptans, opiods, ergots or combination analgesic medications on 10 days per month or more

    - paracetamol, aspirin or NSAIDs, either alone or in any combination on 15 days per month or more.
  • Do not refer people diagnosed with migraine or tension-type headache for neuroimaging, unless they present with one or more features including change in personality, recent head trauma, headache triggered by exercise, cough or sneeze, and impaired level of consciousness (see the draft guideline for the full list of features).

Tension-headaches and migraines are the most common and can often be treated with over-the-counter medicines, such as aspirin, paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. In particular, migraines are reported to affect one in four women and one in twelve men in the UK.

Also in the consultation document, NICE proposes to advise that GPs and other healthcare professionals should offer a NSAID or paracetamol in combination with a triptan for the first line treatment of individual migraines. This is because these combinations appear to be more effective than taking the drugs in isolation.

Importantly, for people who prefer to only take one drug at a time for their migraines, the draft guideline proposes that healthcare professionals should consider monotherapy with a triptan, an NSAID, aspirin (900mg) or paracetamol, if these drugs have not already been tried before by themselves. This gives healthcare professionals and patients a choice of first line treatment options.

Professor Baker added: "Migraines are a major cause of absence from work or school and can cause much discomfort, so it is important the NHS offers treatments that are able to relieve pain as early as possible. Once we publish our final guideline later this summer, we hope its implementation will provide more effective and faster-acting pain relief and reduce unnecessary referrals and revisits. We welcome all feedback from our stakeholders during this public consultation."

The deadline for submitting comments on the draft guideline is 5pm on Thursday 7 June. NICE then expects to publish final guidance for the NHS in September 2012.


Notes to Editors

About the draft guidance

1. The draft guideline on the diagnosis and management of headaches in young people and adults will be available from 00.01, Wednesday 25 April at:

2. Please see page 10 of the draft guideline for the list of headache features, which NICE proposes healthcare professionals should investigate in order to diagnose the correct type of primary headache.

3. For further information about headaches, including statistics and definitions of the different types of headache, please visit NHS CHoices

4. Headache accounts for 4% of primary care consultations and up to 30% of neurology out-patient appointments.

5. More than 100,000 people are absent from work or school because of migraines every working day - this totals around 25 million days a year.

6. All drugs mentioned in the draft guideline should be taken in accordance with their marketing authorisations unless otherwise stated. In particular, aspirin is contraindicated for people under 16 years of age.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 25 April 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.