Headache (a summary of the standard for a family doctor).

Tension headache is not observed. The pain of medium intensity, with no voltage increases.

Migraines are recurrent attacks of moderate to severe, typically unilateral, throbbing pain in nature with nausea and / or vomiting, sometimes celebrated the aura; the pain increases with physical exertion, there is light. Duration of attack is always 4-72 hours.

Migraine in children, see 'Headache'. Differences: it is often two-sided, 30-minute-48 hours. :: Compressing, compress, usually bilateral headache without nausea and vomiting. Duration: minutes-a-days. Increased light and Aura: stereotyped, often visual disturbances before the migraine attack, an hour will begin immediately phase of headache.

Headache due to drug abuse: Chronic headache> 3 dthreeys a week, most of thedayagainst theuseof drugs forheadaches, protivomigrenoznyh drugs or>5 unitfive of coffeea day.
Clusterheadache: paroxysmal in nature,expressed or tearingthrobbing, unilateral around the eyeor temple area, lasting15-180 minutes, forcingthe patientto move(the patientdoes not find a place of pain) occurs in the underrm ofclusters within a few weeks.


The family doctor should pay attention to the following danger signs:

Dangerous Symptoms Differ-th diagnosis
For the first time encountered bouts of headache in people older than 50 years, brain tumor, arteritis temporalis.
The first attacks of migraine over the age of 40 years, brain tumor
Headache in a child younger than 6 years old with a brain tumor, hydrocephalus
Elderly patients with pain in the temple arteritis temporalis
Pregnant with a headache of unclear cause pre-eclampsia
Increasing pain after an injury sub / epidural hematoma
Severe headache against the background of very high pressure Malignant hypertension
Acutely emerged, very severe pain meningitis, stroke, subarachnoid hemorrhage.
Headache with fever (and of consciousness), meningitis
Meningeal symptoms / neurological symmetry we meningitis, brain tumor
Headache with signs of increased intracranial pressure, brain tumor
Symptoms of lateralization of neurologic symptoms of brain tumor
Vomiting in the morning, vomiting not associated with headache a brain tumor.
Changes in personality traits / loss of school success with a brain tumor
Migrainou's aura is always on the same side as the brain tumor.

The family doctor should specify:

  • The nature, severity, time of occurrence (a day), location, duration of headache;
  • Family predisposition was noted whether a similar pain before;
  • Accompanying symptoms (nausea, vomiting), the aura or prodromal symptoms;
  • Aggravating factors (hormonal factor or factors as alcohol or stress);
  • (self-) medication (pain relievers) and the use of caffeinated products (cola, koffie, thee, ice-tea, chocolade);
  • the patient's behavior during the attack (preferred bed rest or vice versa, does not find a place);
  • The degree of pain, limitation in daily life, at work, at home.

Physical examination and additional methods

Not shown in the complaints, pointing to the tension headache, migraine, pain, the abuse of drugs. Sometimes shown to calm the patient.
When a cluster headache can be seen accompanying this suffering symptom.


  • Set the diagnosis of tension headaches, migraine, cluster on the basis of pain complaints.
  • Psychosocial issues can play an important role
  • The combination of different types of headache
  • Keeping a diary of pain at diagnosis neutonchennom

Informing the patient and non-pharmacological treatment

Tension headache increased sensitivity of muscle skull and the insertion of their tendons to the skull. Rational allocation of the burden on them often gives a positive effect.

Migraine established control over pain. Avoid provoking factors (has a limited effect.) Can be effective methods of relaxation and cognitive therapy.

Migraine in children. Consolation-educating parents and children about the short duration of the disease. Recommendations of recovery sleep during an attack of a compliance piece of mind.

Headache abusing drugs. The reason for this excessive use of drugs against headaches or caffeine. I can develop addictive. Tip: cross-sectional end the use of funds.
Cluster pain. Cause of the unknown. Avoid provoking factors during the cluster period .. 'Hereditary predisposition' and 'alternating expansion and contraction of vessels with pulsating pain as a result. " The goal of treatment


Tension headache (first choice) or NSAIDs. Treatment of seizures ALD paracetamol


Treatment of an attack
  • Step 1: metoclopramide or domperidone orally or rectally with a simultaneous appointment of 1000 mg paracetamol or 1200 mg carbasalaatcalcium, or a combined preparation (900 mg acetylsalicylzuur/10 mg metoclopramide).
  • Step 2 (with little effect of step 1): metoclopramide or domperidone and NSAIDs, such as 600 mg ibuprofen or 500 mg naproxen, or 50-100 mg diclofenac.
  • Step 3 (with little effect shaga1 and 2): triptans. Nausea or vomiting, or when intake is insufficient triptaan as a spray from the nose, candles or injection.

Prophylactic treatment with 2 or more attacks per month: b├Ęta-Blocker 100 mg metoprolol 1-2 times per day or 80 mg propranolol 1-2dd, at least six months, if necessary, additional treatment during the attack.
headache on top of head

Prophylactic treatment of migraine during menstruation

  • Three for prior to menstruation and the end of menstruation itself 100 mg metoprolol 1-2 times a day, or 80 mg propranolol 1-2 times a day, or NSAIDs, or estradiol (inside: 2-4 mg per day throughout the menstrual or transdermal: three patches with estrogen on the 50-100 microgram: one patch for three days before menstruation, a patch one day before menstruation and a plaster on the second day of menstruation.
  • Migraine, emerged against the background to the use of birth control - try another.
Migraine during the stop of the week: try to continue taking the contraceptive.

Migraine in children is usually enough paracetamol in sporadic attacks.

Cluster pain treatment during an attack of 100% oxygen, 7-10 liter through a mask for 15 minutes, or 6 mg sumatriptan subcutaneously, or 20 mg as a spray for the nose (max two times) ..

  • Rate control for tension headaches treatment effect in 2-6 weeks.
  • When a migraine - the control effect after 2-3 episodes, with preventive treatment for two weeks for side effects and three months for efficacy.
  • Chronic pain keeps in touch with the patient.
  • Be cautious when renewing prescriptions for painkillers, triptans and ergotamine on the phone.
  • Encourage frequent communication (including telephone) to patients who stopped taking the means by which they abused.


  • When the danger signs.
  • In case of doubt about the diagnosis.
  • When a migraine, the nature of which suddenly changed or the frequency of attacks has increased.
  • The negative result of step 3 in the treatment of migraine.
  • To use other drugs except metoprolol or propranolol at their lack of effect of the prevention of migraine.
  • To assign children with migraine triptanovyh drugs or prophylactic treatment.
  • If the treatment of headaches associated with the abuse of drugs, failed or is unacceptable to the patient.
  • If you suspect a cluster pain or use of preventive treatment for this pain.

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