ABSTRACT
Headache is common, but patients often fear that they have an underlying brain tumour. The headache is severe, usually unilateral and often associated with tenderness of the scalp and temples, aching of the jaw muscles on eating and visual disturbance. In children, visual symptoms are less common and may be simultaneous with the headache, or they may have abdominal pain, vomiting or dizziness without headache. Vestibular neuronitis, benign paroxysmal positional vertigo, and vestibular migraine are common causes of vertigo in primary care. Adults with frequent dyspepsia or heartburn as well as migraine should be tested for Helicobacter pylori – if the presence of Helicobacter is confirmed, eradication therapy may abolish the migraine as well as the gut symptoms. For migraine in adults, National Institute for Health and Care Excellence recommends a combination of a triptan and a non-steroidal anti-inflammatory drug, although monotherapy with a triptan is nearly as effective.
