Summary: Headache is one of the most common symptoms reported in a family doctor's office. The main reason for visiting a family doctor is primary headache, usually migraine, so knowledge of the criteria for diagnosis and the basics of migraine treatment is essential to avoid diagnostic errors, the transformation of symptoms into chronic forms, deterioration in quality of life, medication overuse, and the associated development of medication-induced headaches. Migraine is the most common cause of disability in young women.
Due to limited access to specialist treatment, it is very important to include appropriate acute and, if necessary, preventive treatment of primary headaches at the primary care level. Triptans or gepants can be successfully used in the acute treatment of migraine by family doctors, with particular attention paid to the prevention of headaches associated with the overuse of painkillers. There is no need to fear the use of preventive treatment for migraine or other primary headaches, as proper therapy can reduce the frequency of pain, prevent the abuse of painkillers, and improve the patient's quality of life. Amitriptyline, venlafaxine, candesartan, flunarizine, and even antiepileptic drugs can be safely used in primary care at the doses specified in the recommendations.
Tension headaches are the most common type of primary headache, so knowledge of diagnostic criteria and treatment regimens requires a good understanding of general practice. Secondary headaches are less common than primary headaches and are associated with another specific disease or condition. Knowledge of “red flags,” or symptoms accompanying the pain, can be helpful in deciding whether to pursue further diagnosis or refer the patient to a hospital. It is worth paying attention to patients misdiagnosed with “sinus” headaches, which are most often a mask for migraine, and incorrect diagnosis increases the risk of unnecessary antibiotic therapy or other medical procedures.