Diagnosis & Management of Headache & Migraine

Accurate diagnosis of headache types remains elusive for many individuals.

Common headache types often warrant clinical diagnosis and can be effectively managed in primary care settings. However, for specialized advice on headache diagnosis and management, consulting a neurologist with expertise in headaches or a GP with a special interest (GPwSI) in headaches is recommended.

In some cases, utilizing a headache diary can aid in the diagnosis of primary headaches. Patients are advised to diligently record key details for a minimum of 8 weeks, including the frequency, duration, and severity of headaches, any associated symptoms, medications taken for relief, potential triggers, and the relationship of headaches to menstruation.

Migraine is frequently misdiagnosed as a sinus headache, highlighting the importance of accurate diagnosis and appropriate treatment. Research indicates that a significant proportion of individuals initially diagnosed with sinus headaches are later found to have migraines. These misdiagnoses underscore the need for increased awareness and education regarding migraine symptoms and treatment options.

Imaging for headache & Migraine

Individuals experiencing headaches may harbor concerns about the possibility of a brain tumor. However, in non-emergency situations, current data suggests that the likelihood of discovering serious secondary pathology in patients with isolated headaches and normal neurological examinations is comparable to those without headaches.

While normal imaging may provide short-term reassurance and reduce subsequent healthcare utilization, especially within the first year, its efficacy diminishes in individuals with anxiety and depression over time.

Additionally, there’s a notable risk of uncovering incidental findings in 6-15% of patients, which may not necessitate further management but can heighten anxiety and potentially impact insurance coverage or premiums.

Therefore, the decision to pursue imaging for headaches and migraines should be carefully considered, weighing the risks and benefits, rather than solely seeking reassurance for the patient.

Diagnosis & Management of Headache & Migraine

The unique diagnostic approach that I take at The Health Equation to headache & migraine.

With over 37 years of clinical practice, I’ve developed a unique approach to diagnostic medicine. Patients at our clinic begin with a diagnostic consultation, typically lasting 60 minutes. During this comprehensive session, we delve deeply into various aspects including symptoms, medical history, family history, lifestyle factors, medications, and psychological aspects. This thorough evaluation is complemented by a comprehensive clinical examination, focusing on systems potentially contributing to the patient’s headache or migraine. Common areas of focus include the neuromusculoskeletal, neurological, cardiovascular, and respiratory systems.

One of the highly effective tools we utilize is capnometry, which allows us to measure patients’ breathing behavior. Additionally, heart rate variability monitoring provides insights into their autonomic nervous system response. Many of our patients exhibit breathing pattern disorders and autonomic nervous system dysregulation, particularly those suffering from headache and migraine.

https://www.thehealthequation.co.uk/monitoring-heart-rate-variability-hrv/

https://www.thehealthequation.co.uk/breathing-therapy-and-techniques/

During the history and clinical examination, it sometimes becomes evident that additional investigations, such as blood tests and imaging, may be beneficial. These are discussed on a case-by-case basis and arranged accordingly to aid in the diagnosis and evaluation of the patient’s condition. While many blood test results are reported within standard medical ranges, I also analyze them from a functional medical perspective, utilizing narrower reference ranges to glean more detailed insights into the body’s systems that require attention. If blood tests are conducted, patients receive a comprehensive functional blood analysis report, detailing parameters of concern and their implications within the body.

Following a diagnostic consultation, patients receive a detailed report within two working days, which includes the results of any additional investigations. With the patient’s consent, reports are also shared with referring GPs and medical consultants. If my integrated approach to treatment is deemed beneficial, the report will outline my recommendations, which may encompass Osteopathic Manual Treatment (OMT), dietary adjustments, nutritional supplementation, stress management techniques, breathing re-education, techniques for improving autonomic nervous system balance, and appropriate exercise. This holistic approach may also highlight other clinicians or therapies that could be beneficial, including specialist medical referral.

While it’s crucial to rule out medical causes for headaches and migraines, many patients exhibit functional disturbances. As a recognized expert in exploring the functional factors underlying complex patient presentations, including headaches and migraines, I focus on providing both clinical treatment and education for healthcare professionals.

Successful migraine management typically involves a multifaceted approach, as recommended by the American Academy of Neurology and the American Headache Society. This may include a combination of abortive medications, preventive medications, neuromodulation devices, biobehavioral therapy, nutraceuticals, supplements, complementary and integrative treatment modalities, and biofeedback. Prevention is key in migraine management, with preventative measures recommended for patients experiencing six or more migraine headache days per month, as per the American Headache Society Consensus Statement.

Below is a slide from the Association of Migraine Disorders, which can help you decide whether your symptoms may well be related to migraine.