Web resources on sinister headaches

Dr Keith Barnard recommends websites related to this week's Clinical Review.


This might not appeal to everyone, but those who like lists and schematics should find it useful.

There is some text, but most importantly, tables that help with the evaluation of headache and facial pain. The three tables concern the type of pain, its location, and signs for concern. They could be used as an aide-memoire or as a template for slides for a teaching session.

Why go there: helpful teaching aid.
Downside: not that exciting.
Information from: The Society for Pain Practice Management, Kansas City.
Address: www.sppm.org/FYI/Headache_Facial_pain.htm


This article bears the title 'cutting edge report', although the page is five years old.

However, the content is relevant and interesting, and do not think you have been misdirected when you see 'polymyalgia rheumatica' first.

This item discusses cranial arteritis, mentions the synonyms, and explains its epidemiology, presentation and management.

There is also a discussion of the connection and overlap with polymyalgia rheumatica - in my experience a surprisingly common condition and one of the most gratifying to treat.

It is interesting to note that the clinical spectrum of cranial arteritis is constantly expanding and that it does not always present classically.

We are reminded that the key to the diagnosis of cranial arteritis is a high level of clinical suspicion.

Why go there: the personal narrative style is very readable.
Downside: no illustrations.
Information from: Mount Sinai Medical Centre, New York.
Address: www.rheuma21st.com/archives/cutting_spiera_polymyalgia.html


This is an abstract of a recent study that looked at how effective a specially trained nurse might be in the differential diagnosis of headache disorders.

Patients with non-acute headache disorders and actors who had been trained to role-play presented with benign or sinister headaches and were seen by both the nurse and a consultant neurologist.

There was a high degree of agreement with tension-type headache and migraine, but with other diagnoses the agreement rate fell to only 61 per cent.

Most of these cases would have been referred for a consultant's opinion anyway.

On the face of it, the article's conclusion that a nationwide nurse-led headache service would be a jolly good idea seems reasonable.

However, when I thought about it later, this proposal means training an army of highly paid nurses as well as paying for their premises and support services.

GPs deal with headaches all the time but do not have a special headache clinic and all that that would entail.

There is something wrong here, surely. Have a read of the article, and see what you think.

Why go there: an interesting proposal.
Downside: none.
Information from: Journal of Neurology, Neurosurgery, and Psychiatry
Address: http://jnnp.bmjjournals.com/cgi/content/abstract/76/8/1170


This site belongs to Migraine in Primary Care Advisors, an independent charity founded by GPs, nurses, pharmacists and other healthcare professionals.

The charity aims to improve headache management in primary care. Headache Care for Practising Clinicians is a sub-group of the charity and has an international membership.

Why go there: you might want to join.
Downside: you have to be really interested in headaches.
Information from: Migraine in Primary Care Advisors
Address: www.mipca.org.uk


No, not a hefty half-naked woman coming to give you the ultimate head massage - this title appertains to the rainforests of South America. I hope that this item will appeal to the reader who complained that I missed having a go at a herbal remedy site last week.

Clearly there are those who would sooner trust the shamans of a rainforest thousands of miles away - for it is they who recommend this treatment - than their friendly GP. I find it hard to believe, but then I am not Prince Charles.

For £22.31 you will receive 120 capsules that will relieve pain associated with the central nervous system including migraines, headaches and nerve injuries. The ingredients include such things as tayuya, pau d'arco and mulungu, names that I am sure roll off the lips of consultant neurologists everywhere.

You are advised to take two or three capsules every four to six hours or, if you can find one to get involved, 'as directed by a healthcare professional'. Give me strength.

Why go there: another world.
Downside: need I explain?
Information from: Raintree Nutrition (UK).
Address: www.raintree-health.co.uk/cgi-bin/getpage.pl?/info/1041.html


You will have hours of fun with this, and you should learn something too. This is an interactive tutorial on trigeminal neuralgia, and is so good that I wonder how I ever learnt anything from those massive textbooks.

There is a series of animations on anatomy, causes, medical treatments and gamma knife radiosurgery.

Some of it is quite basic, but it is fun to see pulsating arteries and nerve distributions. I was particularly entertained by the sight of a massive needle zooming in to destroy the Gasserian ganglion.

If you want the whole deal, click on the link to 'a complete guide to trigeminal neuralgia'. This uses the animation, but with more detail, especially of medical treatment, in the accompanying text. Well done, our Canadian cousins.

Why go there: fascinating animations.
Downside: a bit slow to start.
Information from: University of Manitoba
Address: www.umanitoba.ca/cranial_nerves/trigeminal_neuralgia/tutorial.html

- Dr Barnard is a former GP in Fareham, Hampshire.

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