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Summary of guidance relevant to general practice in September 2012

Headaches

Taking medicines such as painkillers over a prolonged period of time to relieve headaches can actually make symptoms worse, according to latest guidelines from NICE.

NICE's first clinical guideline on headaches says GPs and other healthcare professionals should consider ‘medication overuse headaches' as a possible cause for worsening symptoms among patients who have been taking such drugs for three months or more.

It defines medication overuse headaches as when certain drugs are taken up to 15 days per month for three months or more.

These drugs include triptans, opioids, ergots or combination analgesic medications on 10 days per month or more; or paracetamol, aspirin or a non-steroid anti-inflammatory drug, either alone or any combination, on 15 days per month or more.

While there are around 200 distinct types of headache, 95 per cent of headaches are due to four types of treatable disorders, namely tension-type headaches, migraines, cluster headaches, and medication overuse headaches.

The guideline focuses on these four common headache disorders, and aims to improve treatment by providing healthcare professionals with guidance on accurate diagnosis of each type.

Tension-type headaches cause a pressing or tightening, non-pulsating pain of mild or moderate in intensity that is not affected by routine activities of daily living.

Migraine is a pulsating pain, that is throbbing or banging in young people aged between 12 and 17, and that is moderate or severe in pain intensity.

Migraine is also aggravated by routine activities of daily living.

Cluster headache causes bouts of up to 8 headaches per day, with variable pain that is of severe or very severe intensity.

The guideline includes a table with information on the symptoms of each of these types of headaches, offering healthcare professionals information that is easy to refer to for diagnosis.

The guideline also recommends that for all headache disorders, GPs and other healthcare professionals should not refer people diagnosed with tension-type headache, migraine, cluster headache or medication overuse headache for neuroimaging solely for reassurance.

A range of implementation tools have been produced to help support the use of this guideline.

This includes a diagnosis poster, a range of clinical case scenarios that can be used for training and education purposes, and an academic detailing aid.

There is also a podcast with Professor Martin Underwood, Chair of the Guideline Development Group, on the guideline recommendations and impact they have on general practice.

Tobacco: helping people of South Asian origin to stop using smokeless tobacco

Smokeless tobacco products used by some people in South Asian communities are associated with serious health risks such as oral cancer and cardiovascular disease, according to latest NICE guidance.

Many members of the South Asian community use smokeless tobacco products to freshen the breath or to aid digestion.

These products, which include paan or gutkha, are typically served as a mixture which is chewed and consists of betel leaf combined with areca nut, tobacco and spices.

Research shows that particular groups within South Asian communities such as women, those in older age groups and people from Bangladeshi origin, are more likely to use these products.

However, many are not aware that using smokeless tobacco carries health risks such as cardiovascular disease, dental disease, nicotine addiction, problems in pregnancy, and oral cancer.

South Asian women are almost four times more likely to have oral cancer as those from other groups. It is thought that the prevalence of smokeless tobacco among South Asian women is one of the main reasons for this increased likelihood.

NICE's public health guidance on smokeless tobacco cessation for South Asian communities contains a number of recommendations to tackle its use and improve knowledge of its associated health risks.

The recommendations are aimed a range of groups including directors of public health, clinical commissioning groups, dental public health consultants, and faith leaders and others involved in faith centres.

NICE says local need should be assessed to determine the prevalence and incidence of smokeless tobacco use, the products used and the perceived level of health risk associated with the products.

Organisations should collaborate with South Asian communities to plan, design, coordinate, implement and publicise activities to help them stop using smokeless tobacco.

NICE recommends that any materials on smokeless tobacco cessation should refer to the products using the names people use locally.

In addition, information about the risks associated with these products should be provided, as well as information about the availability of services to help people quit.

The guidance also advises that dentists and GPs should use brief interventions to advise those using smokeless tobacco to stop.

Brief interventions include offering verbal advice, discussion, negotiation or encouragement, and typically take no more than a few minutes for basic advice, up to around 20 minutes for a more extended, individually-focused discussion. They may also involve a referral for further interventions or more intensive support.

A range of implementation tools have been produced to help support the use of this guideline.

NICE has published a costing statement to help support the use of this guidance.

26 September 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

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

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

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