BASH Guideline

ACKNOWLEDGEMENTS

Authors for 2019 original version

Fayyaz Ahmed, Hull Royal Infirmary

Anish Bahra, National Hospital for Neurology and Neurosurgery

Alok Tyagi, Queen Elizabeth University Hospital Glasgow

Stuart Weatherby, University Hospitals Plymouth

Authors of subsequent revisions.

Alex Sinclair, University of Birmingham 

David Watson, Aberdeen Royal Infirmary

Jessie Gew, University of Birmingham 

The BASH guideline committee would like to express thanks to the Migraine Trust, the Organisation for the Study of Cluster Headache UK, the Royal Pharmaceutical Society and BASH council for their support, particularly in seeking patient/professional feedback on the utility of this guideline and the development of the patient information sheets. The committee would also like to thank Thomas Hart (St George’s Hospital, London) for his work in preparing the documents for its initial publication.

RATIONALE

The guidance is structured in a brief and relatively didactic fashion and reflects a deliberate decision to achieve three important aims:

1. To create guidance useful to the clinician when seeing a patient in ‘real time’
2. To assist allied health professionals in managing patients with common primary headache disorders using a relatively simple and standardised menu of care
3. To support and facilitate patients in self-management, through use of educational videos, patient information sheets and headache diaries and with a view to developing patient electronic self-management tools in collaboration with national organisations and charities.

METHODOLOGY

A writing committee was established by consensus through the BASH council.

All treatments included in the guideline are supported by randomised placebo- controlled trials. As the level of evidence supporting class A recommendations in international guidelines is not consistent, BASH has therefore chosen only to recommend treatments that are consistently considered to have class A evidence and are recommended in two or more of the following guidelines (NICE, SIGN, AHS & EFNS).

Newer treatments for headache with a specific UK license are also recommended if supported by adequately powered clinical trials with accepted IHS end points and done in a randomised placebo-controlled manner. Other treatment options (with randomised placebo-controlled trial data) are included as appendices.

In recognition of the lack of comparative data, where relevant, treatment options are presented in alphabetical order. The text does not include a comprehensive overview of side effect profiles, adverse events, contraindications, or drug interactions.

When considering therapeutic options, standard resources should be consulted, for example the British National Formulary and the product information sheets. Both prescribers and patients should also note, that while treatment options have placebo control data, not all have a specific license for a headache condition.

The first draft of the BASH Guidelines was sent to BASH council in 2018. The final draft was available from 2019.

In Jan 2026, the document was transformed into a web-based living document, and revisions were implemented. As a living document, sections will be updated over time as required. Subsequent versions will be identified by a version number and date for each section.