Quality standard
Quality statement 1: Classification of headache type
Quality statement 1: Classification of headache type
Quality statement
People diagnosed with a primary headache disorder have their headache type classified as part of the diagnosis.
Rationale
Classifying headache type according to the features of the headache will allow people with a primary headache disorder to receive appropriate treatment and prevention for their headaches. It is recognised that some people will have more than one headache disorder and therefore have more than one classification. Accurate classification and treatment has the potential to reduce referrals for unnecessary investigations and contribute to improved quality of life for people with a headache disorder.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people diagnosed with a primary headache disorder have their headache type classified as part of the diagnosis.
Data source: Local data collection.
Process
Proportion of people diagnosed with a primary headache disorder who have their headache type classified as part of the diagnosis.
Numerator – the number of people in the denominator who have their headache type classified as part of the diagnosis.
Denominator – the number of people diagnosed with a primary headache disorder.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers ensure that systems are in place for people diagnosed with a primary headache disorder to have their headache type classified as part of the diagnosis.
Healthcare practitioners ensure that people diagnosed with a primary headache disorder have their headache type classified as part of the diagnosis.
Commissioners ensure that they commission services that classify headache type for people diagnosed with a primary headache disorder as part of the diagnosis.
People with a headache disorder with no known cause (sometimes called a primary headache disorder) have the type of their headache classified as part of their diagnosis. Common headache types include tension-type headache, migraine and cluster headache.
Source guidance
Headaches in over 12s: diagnosis and management. NICE guideline CG150 (2012, updated 2021), recommendations 1.2.1 (key priority for implementation), 1.1.1 and 1.1.2
Definitions of terms used in this quality statement
Primary headache disorders
These include tension-type headache, migraine and cluster headache, as defined in the headache features table (see the NICE guideline on headaches in over 12s) and which have been diagnosed as a result of excluding other causes and taking a history.
Excluding other causes
The signs and symptoms of secondary headaches for which further investigations and/or referral may be considered as:
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worsening headache with fever
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sudden-onset headache reaching maximum intensity within 5 minutes
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new-onset neurological defect
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new-onset cognitive dysfunction
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change in personality
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impaired level of consciousness
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recent (typically within the past 3 months) head trauma
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headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked) or sneeze
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headache triggered by exercise
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orthostatic headache (headaches that change with posture)
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symptoms suggestive of giant cell arteritis
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symptoms and signs of acute narrow-angle glaucoma
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a substantial change in characteristics of their headache.
Criteria for which further investigations and/or referral may be considered for people who present with new-onset headache are:
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compromised immunity, caused, for example, by HIV or immunosuppressive drugs
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age under 20 years and a history of malignancy
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a history of malignancy known to metastasise to the brain
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vomiting without other obvious cause (for example a migraine attack).
[Adapted from NICE's guideline on headaches in over 12s, recommendations 1.1.1 and 1.1.2]
Equality and diversity considerations
The diagnosis of a primary headache disorder is usually based on subjective symptoms. Some people may need support to accurately describe their symptoms, including children and those with additional needs such as physical, sensory or learning disabilities and people who do not speak English. The support should be tailored to the person, and people presenting with a headache should have access to an interpreter or advocate if needed.