Headache
Birmingham
UHB - the headache service at UHB is intergrated into general neurology clinics. We do have a headache specialist here (Dr Alex Sinclair); however this is a tertiary service and referrals to Alex should come from another neurologist.
Sandwell and West Birmingham NHS Trust - have a specialist headache service overseen by the neurologists at City Hospital but provided by Sister julie Edwards. We have found that patient satisfaction with Sister Edwards's care is very high; she has a lot of experience in dealing with complex headaches and is familiar with a lot of what we would consider to be 'second line' therapies
Birmingham
UHB - the headache service at UHB is intergrated into general neurology clinics. We do have a headache specialist here (Dr Alex Sinclair); however this is a tertiary service and referrals to Alex should come from another neurologist.
Sandwell and West Birmingham NHS Trust - have a specialist headache service overseen by the neurologists at City Hospital but provided by Sister julie Edwards. We have found that patient satisfaction with Sister Edwards's care is very high; she has a lot of experience in dealing with complex headaches and is familiar with a lot of what we would consider to be 'second line' therapies
Rules of thumb - read this first
There are lots of high quality, evidence based, easy to follow, free to access guidelines out there for managing headache.
It accounts for 30% of neurology and an even higher proportion of GP workload and so it is in everyone's interest that headache be managed better.
If a patient has a thunderclap headache or a new headache with papilloedema, pyrexia, confusion, focal neurological deficit or seizures (if you suspect meningo-encephalitis or a venous sinus thrombosis) that is an emergency and the patient should be sent to their local ED.
If the patient has new persistent headache and or red flags (usually personailty change reported by the family; which can be subtle) they should be referred urgently through the Brain and CNS Cancer Pathway.
If the patient has very severe (crying, rocking, not eating), side-locked headache; especially if there is triggering please consider Trigeminal Autonomic Cephalalgia or Trigeminal Neuralgia.
Most other people have migraine or tension type headache (TTH) and should be treated for that. The treatment for migraine and TTH is not co-codamol. Co-codamol should not be used for headache. Don't use co-codamol...
or tramadol.
Stoke
UHNM - has a well established headache service headed by Dr Brendan Davies. There is also a headache nurse.
UHNM operates an Acute Neurology service for severe headache: 'thunderclap headaches', ie.e headaches that reach their peak severity within a few minutes (<5 usually) are dealt with by the on-call neurology SpR who can be reached through switchboard at the Royal Stoke Hospital.
Migraine
Migraine is disabling: if your patient has headaches that are bad enough that they want to go and lie down somewhere, migraine is the most likely diagnosis.
It is possible to have daily headaches with migraine either because the migraine is chronic or because the patient has superimposed medication induced headache. ask about periods of a few hours to a few days where the headache is so bad the patient needs to go and lie down.
Most of the patients seen in neurology clinics have been given a prolonged trial of analgesics. Clearly we are seeing a selected group of patients so it may be that this works in some cases. However it may be better to avoid the chronic analgesic use and go for targeted treatment instead: keep a diary to identify and eliminate triggers; establish a good rescue regime for severe headaches; start the patient on a suitable prohylactic drug at a low dose and work up towards a big dose.