[The practice guideline 'Headache' from the Dutch College of General Practitioners; a response from the perspective of general practice].
The practice guideline 'Headache' from the Dutch College of General Practitioners, which replaces the guideline 'Migraine', is an improvement in many respects: tension headache and substance-induced headache are discussed in detail, the headache diary is given due emphasis and the recommended treatment for migraine is well-balanced. The symptom-oriented approach is, however, not applied consistently in this guideline and too little attention is given, in particular, to the exclusion of serious causes that are less commonly encountered. The guidelines for performing physical examination provide insufficient footing. The exclusion of serious diseases should be based on a limited set of specific physical examinations to be carried out in all cases of new headache. Interrogating the patient about possible social or psychological aspects and the possibility of referral in this area deserve increased emphasis.
de Vries
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VU Medisch Centrum, afd. Huisartsgeneeskunde, Van der Boechorststraat 7, 1081 BT Amsterdam. h.devries@vumc.nl
D003937:Diagnosis, Differential; D005194:Family Practice; D006261:Headache / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D009426:Netherlands; D010808:Physical Examination; D010821:Physicians, Family / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'