Chronic recurrent headache without neurological abnormalities. Practice guidelines of the Netherlands Society of Neurology
Abstract
The diagnosis of chronic recurrent headache without neurological abnormalities is based on the anamnesis and physical examination; EEG or other supplementary examinations as a rule are not indicated. Regarding treatment of migraine, a distinction is made between attack treatment, preferably with non-specific drugs (analgetics and non-steroid anti-inflammatory agents (NSAIDs)) after aural symptoms if any, and prophylactic treatment (agents of choice: beta-receptor blockers). Cluster headache requires adequate treatment as soon as possible after the diagnosis, usually with attack treatment (sumatriptan s.c. or oxygen) as well as prophylactic treatment (agent of choice: verapamil). In the treatment of tension headache, a non-pharmaceutical treatment (relaxation) is to be preferred to pharmacotherapy (tricyclic antidepressants). Patients with chronic recurrent headache should be asked about excessive use of analgetics and caffeine-containing beverages, because these (or abstinence from them) may be the cause of the symptoms.
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