A quick review of the NICE clinical guidelines for chronic headache tells us that when taking a history, be on the lookout for red flags.
If a headache sufferer presents with red flags they may have what is known as a secondary headache which may be a result of pathology, in which case further investigation is required.
If no red flags are present it is likely the headache is primary in nature. This would suggest a functional or physiological cause not related to specific pathology. Migraine and Tension Type Headache are typically primary headaches. When dealing with a primary headache, start treatment using an evidence based approach which may include Medical Acupuncture, unless your patient develops atypical features in which case refer on immediately.
Red flags which may suggest secondary headache include:
- Sudden onset with max intensity within 5 mins
- New onset with hard neurological signs
- Cognitive dysfunction, change in personality
- Headache triggered by cough/ valsalva
- Headache triggered by exercise
- Headache changes with posture
- Hard neurological signs are present
- Symptoms suggesting giant cell arteritis/ glaucoma
- Recent trauma sustained
- Evidence of impaired consciousness
- Extremes of age
Further medical investigation is needed with ANY new headache where the patient has compromised immunity, is under age of 20 or has a history of malignancy known to metastasise to the brain.
So far the vast majority of headaches I have treated with Medical Acupuncture have been primary tension type or migrainous, but I always remind myself to be on the look out for any signs or symptoms suggesting further investigation may be needed. I also tend to inform the patients GP that a headache is being treated and keep in communication as may be required.