Headache

What is Headache? 

Headaches are classed as being ‘Primary’ or ‘Secondary’ headaches.

Primary headaches are the most common headaches that lead people to seek medical treatment. This type of headache isn‘t a symptom but a condition in its own regard - it is a “primary” headache because it is the main concern.

Primary headache disorders include:

  • Tension headache - are described as a pain that feels like a tight band round your head or a weight on top of it.  It is often self-diagnosed and self-medicated so much less commonly seen by health care professionals than migraine. Tension headaches tend to be long headaches lasting more than 4 hours untreated. Patients with tension headache are generally able to continue activities. The Migraine Trust - Tension Headaches

  • Cluster headache - a severe debilitating headache often described as pain that is boring, burning or piercing in nature. It comes on very quickly, often without warning and only affects one side of the head (although it can change sides). It usually occurs behind or around the eye.  It’s a rare type of headache, approximately 1 in 1000 people have it.  OUCH UK

Secondary headache disorders occur as a symptom of another health disorder. Different types of illnesses and disorders can cause a headache, including: 

  • infection
  • head injury
  • vascular such as a bleed into the brain
  • brain tumour

If your health care professional is concerned about secondary headache blood tests and scans are sometimes needed.

Often, taking too many painkillers is a reason a headache can become difficult to treat. This is called medication overuse headache and usually occurs in patients with migraine. Further information is available at The Migraine Trust - Medication overuse headache

How are headaches diagnosed?

The new Scottish National Headache Pathway has been developed to help improve the care that patients receive and ensure consistency across Scotland. It aims to support health professionals to better diagnose and manage headache disorders. This includes those working in general practice and pharmacies, as well as in Neurology departments and emergency departments. The pathway is for use by health professionals to support them in their roles but it can give some useful insights into the pathway taken by your health care team.

Diagnosis is usually made by a health professional taking a thorough history of your symptoms - your story gives the clues to what your headache is. To help with the diagnosis, it can be useful to keep a diary of your headaches for a few weeks. More details on keeping a headache diary and a template can be found at The Migraine Trust - Keeping a headache diary

Health professionals such as those in general practices may refer you to a headache clinic if there is uncertainty about the diagnosis of your headache, for help with management or if a 'secondary' cause is being considered.

What happens at a headache clinic?

The headache clinic team includes a consultant neurologist, a GP with specialist interest in headache, a headache nurse and sometimes trainees in neurology.

Questions will be asked about your symptoms, past and current medication (including over the counter medication, any complementary or alternative remedies) and family history. The doctor or nurse will then discuss the diagnosis and a management plan and may occasionally recommend investigations.

It is usually possible to make a diagnosis during your first appointment. Many patients can be discharged after one visit. However, some patients will need a number of visits especially if their management plan includes hospital only medications. This often involves keeping a detailed diary.

After your visit the clinic will write to your GP practice to inform them about the clinic visit and any treatment that has been suggested.

Further information on headaches can be found at:

 

Published: 10/11/2023 12:06