The National Institute for Health and Care Excellence (NICE) has recently published a Quality Standard for Headache in Young People and Adults: http://publications.nice.org.uk/headaches-in-young-people-and-adults-qs42/
The quality standard relates to the diagnosis and management of primary headache disorders in people aged 12 or over; it also covers medication overuse headache. The National Institute for Health and Care Excellence (NICE) have included a number of quality statements as part of the standard. Two of the statements are particularly relevant to osteopathic practice.
Quality statement 1: People diagnosed with a primary headache disorder have their headache type classified as part of the diagnosis.
Tension-type headache, migraine or cluster headache can be classified using the following table: http://publications.nice.org.uk/headaches-cg150/guidance#diagnosis-2.
More information about headache classification from the International Headache Society is available at: http://ihs-classification.org/en/
Diagnosis of primary headache disorder is achieved as a result of excluding other causes of headache (see below) and taking a case history.
Excluding other causes
NICE clinical guideline 150 (http://publications.nice.org.uk/headaches-cg150/) lists the signs and symptoms of secondary headaches for which further investigations and/or referral may be considered as:
- 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;
- a substantial 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).
Quality statement 2: People with a primary headache disorder are given information on the risk of medication overuse headache.
Information on medication overuse headache is available at:
Patients should be seen by their GP before making any changes to their medication.
Key messages for osteopaths about the headache quality standard
- If you are diagnosing a primary headache disorder, you should classify the type of headache as part of the diagnosis.
- You should provide your patient with information regarding the risk of secondary headache due to medication overuse.
NICE have produced an online summary of their guidance on headaches; it is available at: http://pathways.nice.org.uk/pathways/headaches