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Headache in Family Practice

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Jan Hendrik Oltrogge, Silke Brockmann, Martin Scherer

Keywords: family medicine headache medication-overuse headache migraine tension-type headache

Background: Headache is among the most common medical complaints. The challenge for the consulted family practitioner (FP) consists – in addition to rational diagnostic procedures for the detection of avoidable dangerous conditions – in an adequate patient education and the patient-centered use of non-drug and drug treatment strategies.Search method: This article is mainly based on chapter 2 “Kopfschmerz” (“Headache”) of the German textbook “Duale Reihe Allgemeinmedizin und Familienmedizin”, (5th edition, 2017). In addition, current national and foreign guidelines were consulted and a pragmatic search was performed in the data bank Pubmed under the medical subject heading “headache”.Main messages: Pragmatic diagnostic procedures for the FP can be based on the systematics of the updated International Classification of Headache Disorders (3rd edition, ICHD-III). Medical history and clinical findings are often sufficient, and imaging is usually not necessary. Medication-Overuse Headache (MOH; estimated 1–2 % of all patients with a chronic form of headache) is suspected if there is a headache occurring on 15 or more days/month in a patient with a pre-existing headache disorder.Conclusions: In patients with frequent headache, a careful medical history should be taken by their family practitioner despite other primary reasons for encounter. The use of the ICHD-III allows an effective, evidence-based treatment of the most common acute and chronic forms of headache and reduces the risk of harmful medication overuse.


(State: 19.07.2018)

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