Headache, Mild, Non-Specific

Description

General measures

Medicine treatment

Referral 

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R51

DESCRIPTION

• Headache can be benign or serious
• Headache can have serious underlying causes including:
  • Encephalitis
  • Meningitis
  • Mastoiditis
  • Benign intracranial hypertension
  • Hypertensive emergencies
  • Venous sinus thrombosis
  • Stroke
  • Brain tumour
• Headache due to a serious disease will often be associated with neurological symptoms and signs including:
  • Vomiting
  • Impaired consciousness
  • Fever
  • Pupillary changes and difference in size 
  • Mood change
  • Focal paralysis
  • Cranial nerve fall-out
  • Visual disturbances
  • Convulsions
  • Neck stiffness
  • Confusion
• Tension headache due to muscle spasm:
  • May be worse in the afternoon, but often present all day
  • Is normally felt in the neck and the back of the head, but may be felt over the entire head
  • Is often associated with dizziness and/or blurring of vision
  • Is often described as a tight band around the head or pressure on the top of the head
  • Does not progress through stages like a migraine (no nausea, no visual symptoms)

GENERAL MEASURES

• Teach relaxation techniques where appropriate
• Reassurance, where applicable
• Exclude analgesia overuse headache

MEDICINE TREATMENT

Children

• Paracetamol, oral, 10-15 mg/kg/dose 6 hourly when required. See: dosing table

Adults

• Paracetamol, oral, 500 mg–1 g, 4–6 hourly as required (to a maximum of 4 g in 24 hours).
  • Maximum dose: 15 mg/kg/dose.

REFERRAL

• Refer patients with suspected meningitis immediately after initial treatment. See: Meningitis
• Headache in children lasting for 3 days
• Recent headache of increasing severity
• Headache with neurological manifestations
• Analgesia overuse headache
• Newly developed headache persisting for >1 week in an adult
• Chronic recurrent headaches in an otherwise healthy patient: refer if no improvement after 1 month of treatment
• Tension headache due to muscle spasm: refer if no improvement after 1 month of treatment

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4_Version 1.0_26 May 2025

Chapter 15: Central Nervous System Conditions_15.9 Headache, Mild, Non-Specific