GPs must be alert to medication overuse headaches, NICE says

GPs should be alert to 'medication overuse' in patients with chronic headache and ask patients to halt treatment if this is suspected, NICE has said.

Headaches account for 4% of all primary care consultations
Headaches account for 4% of all primary care consultations

Launching a new headache guideline, NICE said excessive reliance on painkillers led to thousands of avoidable GP consultations for headache each year.

The guideline aims to improve GPs' recognition, diagnosis and management of headaches, including migraine and tension and cluster headaches.

Headaches account for 4% of all primary care consultations, but many are being caused or made worse by patients using drugs such as paracetamol or triptans for more than 10-15 days a month.

Coventry GP Professor Martin Underwood of Warwick Medical School, who led the guideline development, said there were effective treatments for common headache types. ‘However, taking these medicines for more than 10 or 15 days a month can cause medication overuse headache, which is a disabling and preventable disorder,’ he said.

'Explaining to patients that they should abruptly stop their medication, knowing that their headache will get much worse for several weeks before it will improve, is not an easy consultation,’ he said.

Dr Gillian Leng, deputy chief executive of NICE, said: 'Although headache is the most common neurological problem seen by GPs and neurologists, many people are not receiving correct or timely diagnoses.'

Experts behind the guideline also warned GPs to avoid sending patients for a brain scan simply for reassurance.

Dr Manjit Matharu, guideline co-author and a consultant neurologist in London, said he encountered more patients being referred for reassurance than being referred for serious symptom investigation.

Professor Underwood added: ‘Clinical experience is that we see quite a lot of patients who come in with headaches asking for a brain scan because they want that reassurance.

‘Unless you've got grounds for concern, that there is something serious underpinning these headaches... then there is absolutely no need for them to have these scans.'

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