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NICE Quality Standard for Headache in Young People and Adults

The National Institute for Health and Care Excellence (NICE) has recently published a Quality Standard for Headache in Young People and Adults:

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:

More information about headache classification from the International Headache Society is available at:

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 ( 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:!scenariorecommendation

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: