{"id":10980,"date":"2022-10-06T13:40:55","date_gmt":"2022-10-06T12:40:55","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=10980"},"modified":"2024-12-27T10:34:04","modified_gmt":"2024-12-27T10:34:04","slug":"chronic-daily-tension-headache","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/headache\/chronic-daily-tension-headache\/","title":{"rendered":"Chronic daily\/tension headache"},"content":{"rendered":"\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/neuro-headache-Tension-Type.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/neuro-headache-Tension-Type.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Download PDF<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Referral to Neurology for chronic headache \u2013 local guidance<\/h4>\n\n\n\n<p>5 questions to consider before referral:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>CT head?&nbsp;<\/strong>Do you want a clinical opinion or a CT head scan? \u2013 if just the latter then NHS Lothian provides open access CT head. Remember, incidental finding (10%) vs. relevant finding (&lt;0.5%), radiation dose is over 100 chest x-rays and studies suggest it doesn\u2019t provide long-lasting reassurance<\/li>\n\n\n\n<li><strong>Acute Treatments for Migraine (see below links for more detail) \u2013<\/strong>&nbsp;have you tried soluble Aspirin 900mg, Sumatriptan 100mg, Almotriptan 12.5mg, rizatriptan 10mg with anti-emetics? If severe vomiting, try subcutaneous Sumatriptan 6mg.<\/li>\n\n\n\n<li><strong>Preventative Treatment for migraine (see below links for more detail) \u2013<\/strong>&nbsp;have you tried a Beta-blocker (eg Propanolol), Antiepileptic (Topiramate) or Tricyclic (eg Amitriptyline) at&nbsp;<strong><em>therapeutic<\/em><\/strong>&nbsp;doses for&nbsp;<strong><em>3-4 months each.<\/em><\/strong><\/li>\n\n\n\n<li><strong>Treatment of Medication Overuse Headache<\/strong>&nbsp;\u2013 Stop regular analgesia (especially codeine) and limit acute treatment to 10x\/month. Tell the patient they will feel worse for a while and wait for 3-4 weeks before expecting any benefit<\/li>\n\n\n\n<li><strong>Tackle insomnia and fatigue<\/strong>\u00a0\u2013 Many patients with chronic daily headache also have insomnia and fatigue. Improving other causes of these symptoms can improve headache.<\/li>\n<\/ol>\n\n\n\n<p><strong>M.A &amp; J.S. 20-12-22<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/neuro-headache-Tension-Type.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/neuro-headache-Tension-Type.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Tension type headache<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Download PDF Referral to Neurology for chronic headache &ndash; local guidance 5 questions to consider before referral: M.A &amp; J.S. 20-12-22<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3989,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[812],"class_list":["post-10980","page","type-page","status-publish","hentry","category-https-apps-testing28-scot-nhs-uk-refhelp-chronic-daily-tension-headache"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/neurology\/headache\/https-apps-testing28-scot-nhs-uk-refhelp-chronic-daily-tension-headache\/\" rel=\"tag\">Chronic daily\/tension headache<\/a>","rttpg_excerpt":"Download PDF Referral to Neurology for chronic headache &ndash; local guidance 5 questions to consider before referral: M.A &amp; J.S. 20-12-22","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/10980","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=10980"}],"version-history":[{"count":4,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/10980\/revisions"}],"predecessor-version":[{"id":22167,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/10980\/revisions\/22167"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3989"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=10980"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=10980"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}