Mechanisms and management of headache.

Abstract

Headache may be considered as primary or secondary in terms of causality The most common severe primary headache is migraine, affecting 12% of the UK population On the basis of current understanding of the pathophysiology, both migraine and cluster headache may be regarded as neurovascular headaches, not simply as vascular headaches Non-pharmacological management of migraine consists mainly of lifestyle advice, so that sufferers can avoid situations in which attacks will be triggered Preventive treatments for migraine should usually be considered on the basis of attack frequency, particularly its trend to change with time, and tractability to acute care Acute care treatments for migraine can be divided into non-specific (general analgesics, eg aspirin, NSAIDs) and treatments specific to migraine (ergotamine, the triptans) The triptans, sumatriptan, naratriptan, rizatriptan, zolmitriptan and eletriptan, potent 5HT1B/1D receptor agonists, are major advances in the treatment of acute migraine Chronic daily headache in association with analgesic overuse is probably the major avoidable cause of headache in the UK.