Volume 2, Number 2

Andrew Larner MD MRCP Consultant Neurologist, Walton Centre for Neurology and Neurosurgery, Liverpool

Self-help is defined as any self-initiated behaviour seeking health-related information, treatment or reassurance. It can encompass a wide variety of activities, including talking with relatives, friends and neighbours, reading health-related books, magazine or newspaper articles, watching television programmes on health-related issues and consulting medically qualified practitioners or professionals.

David Kernick BSc MD FRCGP DCH DRCOG DA GP, St Thomas Health Centre, Exeter

Cluster headache (also referred to as cluster migraine) is arguably one of the most painful conditions a GP will ever see. Whereas most very painful conditions are self-limiting, cluster headache is ongoing, almost invariably misdiagnosed and usually inadequately treated. Often, sufferers have been to eye departments with suspected glaucoma or to ENT departments with suspected sinusitis.

Giles Elrington MD FRCP Consultant Neurologist, The City of London Medical Centre

The idea that food or its constituents may cause headache is so widely believed that it almost forms part of the collective subconscious of headache sufferers; yet, it is rarely supported by scientific studies. For example, it was believed that vasoactive amines such as tyramine and phenylalanine could trigger migraine in susceptible individuals, though an authoritative review concluded that the relationship with these amines is probably coincidental or purely idiosyncratic, and that most migraineurs do not require severely restricted diets.1

Sue Lipscombe MB ChB MRCP GP, Brighton; Hospital Specialist in Headache, Royal Sussex County Hospital, Brighton

Migraine in Primary Care Advisors (MIPCA) is an independent charity working to set standards for the care of headache sufferers through research and education, and is dedicated to improving headache management in primary care. MIPCA works with academic societies, governmental groups, healthcare professionals and patient organisations that deal with headache.

Edzard Ernst MD PhD FRCP FRCP Ed Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth

Acupuncture is an ancient Chinese treatment, usually involving the insertion of small needles into the skin at special sites called acupoints. Alternative methods of stimulating acupoints, such as heat, pressure, electrical currents and laser light are sometimes used. Acupoints are located along channels (meridians) in which the body’s vital energy (chi) is believed to flow. In traditional Chinese medicine (TCM), ill health is viewed as an imbalance of two opposing energies: yin and yang.

Timothy Steiner PhD LLM MSc MA DIC MRCP FFPM Division of Neuroscience, Imperial College London

Good migraine management has four key elements (see Box 1). Of these, diagnosis and predisposing factors have been covered in previous articles. Explanation allows a patient to hold realistic expectations of what treatment can achieve. Reassurance following diagnosis and explanation is all some patients require, and, in every case, the benefits of reassurance are added to those of therapeutic intervention.