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Headaches and migraines

‘Headache’ is a general term that refers to a persistent or lasting pain in the head: 98% of us will experience a headache at some point in our lives. However, there are many different causes and you may need to seek advice from a doctor.

Why do I need a headache-migraine consultation?

In the case of intense headaches, which have recently started, particularly if the onset is sudden with explosive pain, or if you have neurological damage, please seek advice from your primary care physician or an emergency department.

In the case of headaches that occur regularly, and where you return to feeling normal in between each attack, please speak to your primary care physician during a dedicated consultation to investigate this problem. It is incredibly important that you do not self-medicate on a regular basis, as this may cause serious side effects and potentially help to form a vicious cycle of pain.

A headache-migraine consultation provides care and treatment for anyone suffering from recurrent headaches affecting their quality of life at work and at home. The doctor will firstly assess whether your headaches are:

  • “secondary” headaches and symptoms of an underlying medical condition.
  • “primary” headaches with a stand-alone cause and not the result of another medical condition. Primary headaches include tension headaches and migraines as well as other rarer forms, such as cluster headaches (CH).


 

Migraines

Everyone has heard of migraines, however, there is still often confusion surrounding the difference between migraines and headaches. In the past, migraines have been highly misunderstood, poorly recognised and inadequately treated, often mistaken as a psychological issue. Fortunately, the medical world now has a better understanding of migraines, regarding them as a neurological disorder involving deep brain structures and vessels. A precise definition has been agreed by international experts. 

Even if you are almost certain that you suffer from migraines, and even if your family has a history of migraines, it is important to see a doctor, at least once, to confirm the diagnosis. This ensures that a more serious cause is not overlooked and also means that you can learn more about your condition and receive support when choosing appropriate treatment options.

The diagnosis time is standard, with a diagnosis initially based on detailed history-taking and a full medical examination.

Keeping a ‘headache diary’ is also useful for establishing an accurate diagnosis and monitoring treatment options.

Migraine treatments involve:

  • acute treatments, which aim to completely relieve pain within two hours, without causing any serious side effects, and allowing you to get on with your day.
  • preventative measures, where the aim is to space out the painful episodes, therefore minimising their impact on your quality of life.

Treatments are carefully chosen depending on each individual. We also take into account the different trigger factors that may make headaches worse or increase their likelihood of occurring. Treatment plans can include medication and/or non-medication techniques, including neurostimulation and hypnotherapy. In some cases, patients may be referred to a specialist in interventional pain management for a more advanced level of care.

Preparing for the consultation

Covid-19 pandemic

Advice for migraine patients on taking non-steroidal anti-inflammatory drugs (NSAIDs) during the Covid-19 pandemic

The usual treatments recommended for migraine are NSAIDs and triptans. However, taking anti-inflammatory drugs may potentially exacerbate Coronavirus infection.

Consequently, you are strongly advised to avoid taking NSAIDs (such as ibuprofen, ketoprofen, mefenamic acid, diclofenac or naproxen) throughout the Covid-19 pandemic, especially if you have symptoms of a viral infection, which include fever, cough, difficulty breathing and rhinitis. 

In case of a migraine attack, you should therefore take Triptan. Paracetamol can be used if needed (at a maximum dosage of 3 g per 24-hour period). Aspirin at a dose of 500 mg or 1 g is also an anti-inflammatory and should also be avoided, therefore.