Oxford University Hospitals NHS Foundation Trust

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Oxford Headache Centre referrals

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The Oxford Headache Centre is a multidisciplinary team for helping people with difficult headaches.

The following clinicians are responsible for headache services at the John Radcliffe Hospital.

Consultant Neurologists

  • Professor Zameel Cader
  • Dr Ben Wakerley
  • Dr Paul Davies

Consultant Neurosurgeons

  • Mr Alex Green
  • Professor Tipu Aziz

Specialist Nurses

  • Alejandro Rubio-Diaz
  • Kally Patel

Specialist Physiotherapist

  • Sarah Haynes

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Who to refer to the Oxford Headache Centre

If you have patients with difficult-to-treat headache, or a rare headache type, then we would be able to see them.

This might include:

  • Refractory Headaches
  • Chronic Headaches
  • Cluster Headache
  • Trigeminal Autonomic Cephalalgias
  • Idiopathic Intracranial Hypertension

To make an appointment with the Oxford Headache Centre, please use Choose & Book.

If your patient would like to be seen privately, please contact:

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For advice or to discuss a patient

You can book a telephone slot to speak with Professor Cader on a Tuesday morning.

Will my patient need a scan?

Most headaches do not have a sinister cause, and most patients with headache will not need a scan. They should not be requested to alleviate anxiety.

Headaches are not a good predictor of whether someone has a brain tumour.

Getting a scan can also result in further problems and anxiety, if an incidental finding is identified.

A brain scan should therefore only be considered if there is significant suspicion of secondary cause or the patient is in a vulnerable group (e.g. immunocompromised, very young, previous history of malignancy).

If you think your patient may have a secondary headache, please refer as described below. Further guidance is available from NICE:

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Consider referral to Emergency Department or Emergency Medical Team

  • Sudden severe headache (like a 'thunderclap', peaking within five minutes) - could this be subarachnoid haemorrhage?
  • Headache with an impaired level of consciousness.
  • Worsening headache with fever or rash - could this be meningitis?
  • New headache in someone over the age of 50 years and features such as jaw claudication, visual symptoms, scalp tenderness - could this be Giant Cell Arteritis?
    • Start Prednisolone 40-60 mg
    • Check ESR
    • If visual symptoms (e.g. amarosis fugax) refer to Eye Casualty
    • Refer to Rheumatology for biopsy and further advice

Refer to General Neurology

  • New onset headache with associated neurological deficits, cognitive changes or personality changes.
  • New onset headache in someone over the age of 50 years.
  • Headache that changes with posture.
  • Headache triggered by exercise, cough, sneeze.
  • Coital headaches.
  • A previous history of malignancy.
  • A new headache in someone with compromised immunity (e.g. HIV).

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Managing headaches in the community

Most headaches you see in your practice will be a primary headache disorder, and most of these will be migraine.

If you have excluded red flag features, then a presumptive diagnosis of migraine is a good place to start.

Migraines

  • Moderate-severe intensity.
  • Disruptive of day-to-day life.
  • Associated features such as nausea, photophobia and phonophobia.

Acute migraine treatment

  • NSAID e.g. ibuprofen 600 mg; Aspirin 900 mg; Paracetamol 1 g
  • Triptans e.g. sumatriptan 50 mg, zolmatriptan 5 mg nasal spray

Should be taken as soon as possible after start of migraine headache.

Preventative migraine treatment:

  • Beta-blocker (e.g. propranolol 80 mg daily)
  • Tricyclic (e.g. Amitriptyline 20 mg daily)
  • Topiramte (start 25 mg daily and increase to 50-100 mg daily)

These drugs will take up to eight weeks before an effect is noticeable.

The aim should be a 50 percent reduction in headache frequency and/or severity.

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Analgesic overuse

AVOID OPIATE ANALGESICS (e.g. codeine, tramadol) for headaches.

Any analgesic, including paracetamol, if used on more than 15 days per month can lead to analgesic overuse and a worsening/chronification of headaches. It can make headaches refractory to preventative treatments.

Opiates and triptans can cause this problem if taken on more than 10 days per month.

Please advise your patients about the risk of analgesic overuse.

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