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Migraine in Primary Care Advisors


Treatment guidelines for chronic daily headache


Goals of therapy

Relieve the pattern of chronic headaches and reduce the impact on the patient’s activities of daily living.

First-line treatments

Follow up

When a successful response is achieved, prophylactic medications can be withdrawn gradually, relying solely on acute medications for relief of the original episodic headache. However, if one prophylactic medication fails, another may be tried.

When to refer

The GP who is experienced in headache management should be able to successfully manage most patients with chronic daily headaches. However, referral to specialist neurology or headache services may be necessary when:

The GP who is not so experienced in headache management may wish to refer all their patients who have chronic daily headaches.


Dowson AJ, Bradford S, Lipscombe S et al. Managing chronic headaches in the clinic. Int J Clin Pract 2004; in press.


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