Supporting good headache management

National guidelines, classifications and measures to help professionals with diagnosis and management

British Association for the Study of Headache (BASH)

The British Association for the Study of Headache (BASH) is the United Kingdom national society member of the International Headache Society (IHS) and the European Headache Federation (EHF). Its membership is open to all healthcare professionals with an interest in headache. BASH works closely with The Migraine Trust to support the development of headache service delivery.

BASH Management Guidelines

The Association produces the BASH Guidelines for the diagnosis and management of migraine, tension-type, cluster and medication-overuse headache. The BASH Guidelines are intended for use by all healthcare professionals and have been written by headache specialists who base the Guidelines on existing evidence and clinical experience. The latest edition of the Guidelines is available to download from the BASH website.

International Classification of Headache Disorders

Produce by the International Headache Society (IHS), the International Classification of Headache Disorders is described as the “single most important document to read for doctors taking an interest in the diagnosis and management of headache patients”.

The International Classification of Headache Disorders, 3rd edition beta (ICHD-III) classifies all headache disorders into major groups and then subdivides them into headache types, subtypes and subforms. The practising family physician may only need to diagnose at the first level in order to select acute treatment. However, when there is a problem of differential diagnosis it becomes necessary to distinguish between one headache type and other disorders that may mimic it, and thus to code at the second or third levels. Practising neurologists and headache specialists would normally diagnose the precise subform of a headache type at the third level.

Scottish Intercollegiate Guidelines Network (SIGN)

The Scottish Intercollegiate Guidelines Network (SIGN), that works to improve the quality of health care for patients in Scotland by reducing variation in practice and outcome, has produced a patient booklet (SIGN 155 Pharmacological management of migraine), which provides recommendations on the pharmacological management of adults with acute migraine, and prophylaxis for patients with episodic or chronic migraine or medication overuse headache.

National Institute for Health and Care Excellence (NICE)

NICE guidelines (CG150) – Headaches in over 12s

NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases, in this case headache, and the treatments they should receive. The headache guidelines offer evidence-based advice on the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster headache and medication overuse headache in young people (aged 12 years and older) and adults. The guidelines apply to people using the NHS in England and Wales.

NICE quality standard (QS42) – Headaches in over 12s

NICE quality standards are a set of prioritised statements that aim to drive measurable quality improvements within a particular area of health or social care.  They set out what high quality standards in look like rather than just a minimum standard.  The quality standards are based on existing evidence based guidance e.g. NICE guideline on headache, and are developed independently in collaboration with health professionals, patients and patient organisations etc. The Migraine Trust represented migraine sufferers on the committee as a lay member.

NICE Clinical Knowledge Summaries (CKS)

The NICE CKS service provides primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice in respect of over 330 common and/or significant primary care presentations.

There are separate CKS topics on migraine, headache – assessment, cluster headache, medication-overuse headache, tension-type headache and trigeminal neuralgia to name a few.

MIDAS migraine disability assessment

The MIDAS (migraine disability assessment) questionnaire was created to help measure the impact headaches have on a person’s life. It was developed by Richard B. Lipton, MD, Professor of Neurology, Albert Einstein College of Medicine, New York, NY, and Walter F. Stewart, MPH, PhD, Associate Professor of Epidemiology, Johns Hopkins University, Baltimore, MD.  The American Headache Society has a tool for carrying out the assessment on the ACHE website.

PatientPlus – migraine

PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. See their information on migraine diagnosis, examination and management.

Headache Impact Test

The Headache Impact Test (HIT) is a tool to measure the impact headaches have on a person’s ability to function on the job, at school, at home and in social situations.  The score a person gets shows the effect that headaches have on normal daily life and their ability to function.  HIT was developed by an international team of headache experts from neurology and primary care medicine in collaboration with psychometricians.

I-D Migraine Test

The I-D Migraine test is a simple 3-step test for patients. Lipton RB, Dodick D, Sadovsky R, al. e. A self-administered screener for migraine in primary care: the ID Migraine ™ validation study. Neurology 2003; 61:375-382