BASH Guideline

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Table of contents

Overview

Section 1: The Clinical Approach

1.1 Clinical assessment of headache

1.2 The role of imaging in headache

1.3 When to consider secondary headache

Section 2: Primary Headaches

List of abbreviations

References

Overview

Acknowledgements, rationale and methodology

Section 1

1.1 Clinical assessment of headache

1.1.1 Classification

1.1.2 How to differentiate primary from secondary headache

1.1.3 Using the temporal pattern of headache to help differentiate primary from secondary headache

1.1.4 Differentiating between common primary headache disorders

Table 1: Comparative table to distinguish between common primary headache disorders

1.1.5 Examination

1.2 The role of imaging in headache

1.3 When to consider secondary headache

1.3.1 Identifying headache due to secondary causes

1.3.2 Thunderclap headache

Section 2

2.1 Migraine

2.1.1 Epidemiology

2.1.2 Clinical features

Table 1: International headache classification definitions of migraine

2.1.3 Migraine management

A) General principles

B) Acute treatment

C) Choosing a triptan

Table 2: Calculated numbers needed to treat for acute migraine therapies for an outcome of pain free at two hours in patients with moderate to severe pain, compared to placebo.

D) Gepants (CGRP antagonists)

Table 3. Recommended acute treatments – simple analgesics and antiemetics

Table 4. Recommended acute treatments – triptans

Table 5. Recommended acute treatments – gepants

E) Preventative treatment

Table 6. Recommended preventative treatments in episodic and chronic migraine.

Table 7. Recommended preventative treatments for episodic migraine only

Table 8. Recommended preventative treatments for chronic migraine only

F) Menstrual migraine

T able 9: Recommended triptans for short term prevention of menstrual related migraine or pure menstrual migraine

G) Treatment in pregnancy & breastfeeding

Appendix 1. All preventative treatments for migraine

Appendix 2. All treatments for short term prevention of menstrual related migraine or pure menstrual migraine

2.2 Medication overuse headache

2.2.1 Epidemiology & diagnosis

2.2.2. Clinical features

2.2.3 Management

A) Patient education

B) Medication withdrawal

2.2.4 Prognosis

2.3 Tension-type headache

2.3.1 Epidemiology

2.3.2 Clinical features

2.3.3 Management

Table 1. Recommended acute treatments in tension-type headache

Table 2. Recommended preventative treatment in tension-type headache

Appendix 1. All acute treatments in tension-type headache

Appendix 2. All preventative treatments in tension-type headache

2.4 The trigeminal autonomic cephalalgias

2.4.1 Cluster headache

2.4.1.1 Epidemiology

2.4.1.2 Clinical features

2.4.1.3 Management

A) Acute treatment

Table 1. Recommended acute cluster attack treatments

B) Preventative treatments

Table 2. Recommended preventative treatments for cluster headaches

Appendix 1. All acute cluster attack treatment

Appendix 2. All preventative treatment for cluster headaches

Appendix 3. Classification of cluster headache

2.4.2 Paroxysmal hemicrania

2.4.2.1 Epidemiology

2.4.2.2 Clinical features

2.4.2.3 Management

A) Acute treatment

B) Preventative treatment

Appendix 1. Classification of paroxysmal hemicrania

2.4.3 SUNCT/SUNA

2.4.3.1 Epidemiology

2.4.3.2 Clinical features

2.4.3.3 Management

A) Acute treatment

B) Preventative treatment

Appendix 1. Classification of SUNCT/SUNA

2.4.4 Hemicrania continua

2.4.4.1 Epidemiology

2.4.4.2 Clinical features

2.4.4.3 Management

A) Acute treatment

B) Preventative treatment

Appendix 1. Classification of hemicrania continua

Appendix 2. Differential diagnosis of the trigeminal autonomic cephalalgias and trigeminal neuralgia

Abbreviations

References

BASH Guideline V1.0 2019

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BASH Guideline

BASH Annual Headache Conference &

Guidelines Launch

Date: February 25-26, 2027

Location: Birmingham