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The only problem with the polypill is that it doesn't go far enough ... with the polypill is that it doesn’t go far enough. If I was in charge of the pestle and mortar, I’d slip in the following: Amitriptyline: my 'Desert Island' drug. It helps insomnia, IBS, migraine, OABs, neuropathy, tension and fibromyalgia, all of which I have by close of play on a Monday. Only a low dose, tragically. Remember when we dished out 150mg/day for depression? Happy days. Literally. SGL ... Date: 12-03-2025 Categories: • Cardiovascular • Copperfield
MHRA opens up for more medicines to become available without a GP prescription More medicines could be switched from prescription-only medicines (POM) to pharmacy medicines (P), as the Medicines and Healthcare Products Regulatory Agency (MHRA) has encouraged medicines manufacturers to ... Date: 11-02-2025 Categories: • Dermatology and wound care • Gastroenterology and obesity • Respiratory • Women's health, gynaecology and obstetrics
The ‘clinic clichés’ that stop us in our tracks ... looking down at the floor as he slowly entered the room. 'My head's banging doc,' he started, grimacing in pain. I could believe he was in the throes of an acute migraine looking at him hunched up in front of me. I soon realised he was very serious about jumping off a bridge that evening. The physical symptoms were exacerbated by his mental state - as is so often the case with our patients - and although ... Date: 24-09-2024 Categories: • Writing Competition 2024
Triptans better than newer more expensive drugs for migraine, say researchers GPs should prescribe more triptans for the treatment of migraines, say researchers who found them to be the most effective option but underused. An extensive study by a team across Europe comparing all treatments found triptans to be more effective than newer m ... Date: 19-09-2024 Categories: • Mental health, pain and addiction
Rise in GP practices participating in research studies ... they wouldn’t otherwise be able to access.’ The health centre supports a mix of commercial and non-commercial studies, including trials that looked into diabetes, flu, RSV, migraines, smoking cessation and more. In total, there were 6,074 CRN-supported studies in England in 2023/24. Around a third of were commercial trials (29%), which are fully funded by the life sciences industry, while 10% were ... Date: 16-08-2024 Categories: • Diabetes and endocrinology
Migraine: Myths and Facts In the first of a new series exploring some common misconceptions about conditions seen in general practice, GP and headache specialist Dr Richard Wood debunks some myths about migraine – and explains some perhaps less well known facts Myths 1. Chocolate and caffeine are common dietary triggers and should be avoided by migraine sufferers While some foods can sometimes be a ... Date: 18-04-2024 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction • Neurology
NICE recommends first oral drug for preventing both chronic and episodic migraines The first oral drug for preventing migraines where other treatments have failed should be available on the NHS, NICE has recommended in final draft guidance. Up to 170,000 people could be eligible for atogepant - also known as Aquipta - und ... Date: 11-04-2024 Categories: • Neurology
Rational referrals: Neurology ... appropriate A&G requested from secondary care when required. Patients and clinicians can be pointed towards online resources such as the British Association for the Study of Headache, the Migraine Trust and the Organisation for the Understanding of Cluster Headache for useful information regarding diagnosis and management. Sensory symptoms. The distribution of isolated sensory symptoms often ... Date: 26-03-2024 Categories: • Mental health, pain and addiction • Neurology
Masterclass: A complete GP’s guide to menopause and perimenopause ... tion, dyspareunia; dysuria, urinary frequency and urgency, and recurrent lower urinary tract infections); reduced libido; sleep disturbance; joint and muscle pains; headaches (including worsening migraine); fatigue. Investigations Do not routinely use follicle-stimulating hormone (FSH) to diagnose perimenopause or menopause in women not using hormonal contraception aged over 45 years with typical me ... Date: 14-03-2024 Categories: • Long-term conditions and prescribing • Women's health, gynaecology and obstetrics
NHS England reiterates call for GPs to curb OTC prescribing NHS England has reiterated guidance asking GPs to limit prescribing of over the counter (OTC) medicines, in a bid to improve 'value for money'. The policy, which was first introduced in 2018, recomm ... Date: 14-03-2024 Categories: • Dermatology and wound care • Long-term conditions and prescribing • Respiratory • Women's health, gynaecology and obstetrics
CPD: Key questions on primary headache disorder GP and headache specialist Dr Richard Wood answers key questions on primary headache disorder, including how to reach a definitive diagnosis of migraine, best management approaches for migraine and tension-type headache and how to recognise and treat other types such as cluster headache Key points Primary headache disorder refers to heada ... Date: 01-03-2024 Categories: • CPD • Long-term conditions and prescribing • Mental health, pain and addiction • Neurology
Supporting autistic patients ... axia, dyslexia, dyscalculia and Tourette’s. Mental health challenges, including disordered eating, depression, anxiety, self-harm and suicidality. Neurological conditions, including epilepsy, migraines, and autonomic dysfunction. Gastrointestinal conditions, including gastric dysmotility and irritable bowel syndrome. Variant connective tissue, including Ehlers Danlos Syndrome and other forms o ... Date: 09-02-2024 Categories: • CPD • Mental health, pain and addiction • Neurology
Clinical Clanger: 'Can I have some more prochlorperazine for my dizziness?’ ... o (BPPV) should be treated with the Epley manoeuvre – medication is ineffective due to the severe and very transient nature of the vertigo in BPPV. Vestibular migraine is much more common that previously realised and the reduction in stressors through regular, good-quality meals and sleep is of much greater importance than medication. The evidenceNICE has guidance on the manag ... Date: 27-10-2023 Categories: • Ear nose and throat and ophthamology • Neurology
Women's health: Menopause and HRT ... ptoms are the most well-known, but symptoms include: low mood, anxiety, reduced self-esteem, poor memory and concentration, reduced libido, joint pains, vaginal dryness, bladder issues, and worsening migraine2. Diagnosis Follicle-stimulating hormone (FSH) testing is not required to confirm the diagnosis of menopause in those aged > 45 if (a) they have vasomotor symptoms and irregular periods (b) ... Date: 22-09-2023 Categories: • Clinical areas • Women's health, gynaecology and obstetrics
NICE to recommend rimegepant as first acute migraine treatment NICE has approved rimegepant as the first treatment for acute migraine, in draft guidance published today. Around 13,000 could benefit from rimegepant (Vydura, Pfizer), said NICE after signing off its use in adults who have tried at least two triptans but they did no ... Date: 14-09-2023 Categories: • Mental health, pain and addiction • Neurology
Red flags in assessing acute vertigo ... Recent or ongoing URTI may predispose to peripheral vertigo, as viral infections can cause vestibular neuritis, labyrinthitis or even induce inner ear inner ear canalithiasis (BPPV). A history of migraines is relevant, as migrainous vertigo or vestibular migraine is more prevalent in clinical practice than commonly believed. Recent head trauma can lead to central vertigo, warranting an urgent asses ... Date: 11-08-2023 Categories: • Neurology
NICE says its new approval process has sped up access to medicines ... load being able to be cut by 25-45%. Medicines that have been through the new faster process include nintedanib for idiopathic pulmonary fibrosis and eptinezumab for treating migraine both of which were eight weeks faster than normal. ‘Those achievements were possible because we worked closely with partners and stakeholders to offer flexible solutions to issues of data and value,’ Dr Roberts said. ... Date: 12-07-2023 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction • Technology
GPs advised to use QRISK3 CVD score for certain patient groups ... has admitted. In a primary care bulletin this week, NHS England said when assessing risk for patients taking corticosteroids or atypical antipsychotics or people with systemic lupus erythematosus, migraine, severe mental illness or erectile dysfunction, GPs should use QRISK3 moving to the online version if needed. Updated cardiovascular disease risk assessment and reduction guidance from NICE recomm ... Date: 08-06-2023 Categories: • Cardiovascular
NICE approves novel oral drug rimegepant for preventing migraine Draft NICE guidance has approved rimegepant, a novel oral drug for preventing migraine, which it said could become available to 145,000 NHS patients. Rimegepant is the first drug of its class to come in pill form, with other similar medications administered as injections. The calcit ... Date: 31-05-2023 Categories: • Mental health, pain and addiction • Neurology
EMIS to continue offering QRisk until next year ... messages. It comes as GP practices are expected to move to routinely using QRisk3, an updated version of the risk score that takes into account other factors including migraine and severe mental illness. In recent updated draft guidance on statins, NICE said QRisk3 performed best in assessing cardiovascular risk in a UK population. The email added: ‘We are awaiting guidance from NHS England on ... Date: 24-03-2023 Categories: • Cardiovascular • Technology
GPs raise workload and safety concerns over loss of QRISK calculator from IT system ... res manual input of the relevant data. It comes as GP practices are expected to move to routinely using QRISK3, an updated version of the risk score that takes into account other factors including migraine and severe mental illness. In recent updated draft guidance on statins, NICE said QRISK3 performed best in assessing cardiovascular risk in a UK population. ‘Until systems are updated with QRIS ... Date: 10-02-2023 Categories: • Cardiovascular • Technology
Clinical clangers: 'My headaches are getting worse, doctor – it must be my blood pressure’ ... on can often be dealt with on the phone. If there are no red flags, and the headache sounds like something benign (for example, a tension headache) or is a flare of a known condition such as migraine, then reassurance and simple advice might be sufficient. Avoid checking the patient’s BP as it is likely to be raised and this risks overdiagnosis of hypertension or unnecessary investigations. Expla ... Date: 13-10-2022 Categories: • Cardiovascular • Mental health, pain and addiction • Neurology
How to consult remotely: headache ... nfident of managing the initial process over the phone or by video, for those patients happy to consult remotely. However, as presentations become more complex, particularly with chronic migraine which can be associated with a number of comorbidities, face-to-face consultations are preferable for identifying important subtle clues and enhancing information gathering and communication. The thre ... Date: 22-06-2022 Categories: • Neurology • Remote consultations
How to consult remotely: contraception ... (BP) and other factors in the Faculty of Reproductive and Sexual Healthcare (FRSH) UK Medical Eligibility Criteria for Contraceptive Use (UK MEC).2 Ensure the patient has no prior history of migraine with aura, and document this. It may be necessary to remotely record weight, body mass index (BMI) and BP for safe prescribing. Patients can self-report these observations with home measurements, or with ... Date: 13-05-2022 Categories: • Long-term conditions and prescribing • Sexual health • Women's health, gynaecology and obstetrics
All the reaction to the NHSE £250m package for general practice ... re admin staff. £250m time-limited which may not actually be extra money is quite frankly an insult. Staff and doctors are burning out here. As I write, I'm at work with a horrible migraine and feel sick. Today's news has made this worse. I'm duty doc this afternoon. If I go off sick with the stress-related migraine, who will call the 15 patients I have booked in? Who will process 100 letters, check 100 r ... Date: 14-10-2021 Categories: • Contract • NHS rescue plan
Preventing access is no way to deal with rising demand ... eed of access are simultaneously failing to get through. There is risk hidden in every waiting list, and that risk increases the longer the waiting list grows. Is a patient’s headache simply a migraine, or is it a subarachnoid haemorrhage? Is the pain in your patient’s stomach something trivial, or acute appendicitis? It is true that some digital health services actively increase the demand for prim ... Date: 02-07-2021 Categories: • Practice life • Pulse PCN
Pregnant women on sodium valproate to be reminded to urgently see GP ... age, unless they are on a pregnancy prevention programme. GPs have also been advised that they must not prescribe valproate for bipolar disorder or migraine and that they must not prescribe the drug for epilepsy unless there is no other effective treatment available. Date: 15-06-2021 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction • Neurology • Women's health, gynaecology and obstetrics
Ten top tips: Headache after AZ Covid vaccination (updated 21 April) ... comfortable reassuring a patient with a headache after vaccination if I can give them a plausible reason for their headache. Does it fit with a flare of pre-existing migraine, tension headache or something else already known? Or is there another reason to be concerned? Meningitis, mastoiditis, intracranial bleeds and tumours haven’t gone away just because we’re all thinking about CSVT. If you can’t fi ... Date: 21-04-2021 Categories: • Covid-19 • Infectious diseases, immunology and allergy • Mental health, pain and addiction • Vaccinations, prevention and screening
Erenumab recommended for some migraine patients under commercial deal NICE has recommended erenumab for treating migraine in some patients after earlier drafts of the guidance were appealed. Patients who have four or more migraine days a month and who have already tried at least three other preventive medicines will ... Date: 10-03-2021 Categories: • Mental health, pain and addiction • Neurology
How to deal remotely with… HRT prescribing ... Key pointers in the history • Are there any contraindications to HRT or reasons to be cautious? Specifically ask about relevant history such as VTE, cardiovascular disease, migraine, breast or ovarian cancer, thyroid or liver/gallbladder disease. • Is she sexually active? Consider her need for contraception. HRT is never contraceptive.8 • A computer template for HRT initiation and repeat prescrib ... Date: 11-02-2021 Categories: • Women's health, gynaecology and obstetrics
Appeal success on NICE guidance on erenumab for preventing migraine NICE is likely to recommend erenumab for preventing migraine later this month (January 2021) after earlier drafts of the guidance were appealed. In final draft guidance, the committee ruled that the treatment would be cost effective in patients who had trie ... Date: 11-01-2021 Categories: • Neurology
NICE recommends new migraine treatment for up to 200,000 patients in the UK NICE has recommended a new treatment for migraine prevention that around 200,000 patients in the UK could be eligible for. Galcanezumab, known as Emgality, is a monthly injected treatment for the prevention of migraine in adults with both chronic ... Date: 19-11-2020 Categories: • Long-term conditions and prescribing • Neurology
Introducing the GP behind the new PulseToday Covid toolkit ... Hospital for Neurology and Neurosurgery, Queen Square and UCLH Mr James Tysome, Consultant ENT Surgeon, Cambridge University Hospitals Dr Marcus Lewis, GPwSI in Headache and Migraine, Camden Dr Dana Beale, Specialist GP and Homeless Health Lead for North West London Dr Siobhan Gee, Principal Pharmacist, Liaison Psychiatry, South London and Maudsley NHS Foundation Trust& ... Date: 16-11-2020 Categories: • Covid-19
NICE issues new draft guidance for 6-8 week GP postnatal check ... problems • persistent or severe headache, which could indicate hypertension, pre eclampsia, postdural-puncture headache, migraine, intracranial pathology or infection. 1.2.5 At each postnatal contact, give the woman the opportunity to talk about her birth experience, and provide information about relevant support services, if appropriate. Source: NICE Date: 21-10-2020 Categories: • Women's health, gynaecology and obstetrics
Non-febrile seizures in a child or young person ... ve epilepsy.1 The misdiagnosis rate of epilepsy in the UK is approximately 30%. Other conditions that can be misdiagnosed as seizures include faints, daydreaming, panic attacks, sleep disturbance, migraine, breath-holding, cardiac abnormalities or non-epileptic attacks (pseudo-seizures). 2 Understand the diagnostic criteria for epilepsy Epilepsy is the commonest significant neurological disorder ... Date: 12-10-2020 Categories: • Paediatrics
Non-Covid clinical crises: Cluster headaches Cluster headaches are frequently misdiagnosed and inadequately managed. The key is to ask patients what they do during an attack. Migraine suffers will want to lie quietly in a darkened room but a patient with cluster headache will be agitated, rock back and forth, and pace the room. Important differences between migraine and cluster h ... Date: 09-04-2020 Categories: • Clinical crises • Neurology
Non-Covid clinical crises: Potential brain tumour ... f directly available and not resolving): new headache where a diagnostic pattern has not emerged after eight weeks from presentation. The majority of headaches presenting to general practice will be migraine. headache aggravated by exertion or Valsalva’s manoeuvre headaches that have been present for some time but have changed significantly (here interpretation may be difficult) new headache in a patient ... Date: 09-04-2020 Categories: • Clinical crises • Neurology
Contraception: How to manage without face-to-face consultations - 19 March ... nurse (if so ask for her latest weight measured on her home scales) • Any change in her medical status (any new medical problems or being investigated for any new medical conditions, including migraine, VTE, hypertension or change to any medication she is taking) • Any change in her family history since she was last seen (e.g new family history of DVT /PE) If a repeat prescription of the combined pill/ ... Date: 06-04-2020 Categories: • Covid-19 resources • Sexual health • Uncategorised
The human connection ... ey can’t hoodwink me into a buy-one-get-one-free consultation, when you hope to squeeze in a one-minute call to explain a test result, but 10 minutes later you’re still hearing about piles, migraines and indigestion. The cardy-wearers may want a 15-minute chat about lifestyle choices, but back on earth we are firefighting so a quick text will do just fine, thanks. But on the whole, the march to tech for t ... Date: 18-02-2020 Categories: • Covid-19 • Nabi
GPs need to be alerted to beta blocker overdose risk, says NHS safety watchdog ... sk of toxicity if the drug is overdosed. The investigation was prompted by the case of a 24-year-old woman who died in 2018 after taking an overdose of propranolol, which she had been prescribed for migraines, and citalopram. She deteriorated rapidly before an ambulance was able to reach her. The report found that propranolol is prescribed widely and generally without clinical incident in primary care, mo ... Date: 06-02-2020 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction
Rage against the migraine A friend of mine phones her surgery. She knows a thing or two about migraines, having suffered from them for years, and just wants an appointment to discuss restarting prophylaxis. No chance. Not for the foreseeable future. Oh. OK then, how about a telephone call from the GP ... Date: 26-11-2019 Categories: • Copperfield • Regulation • Uncategorised
Safe HRT prescribing ... e within 10 years of their menopause onset, it can reduce their future risk of developing osteoporosis, type 2 diabetes, osteoarthritis and all-cause mortality.4-6 More on menopause: menopause and migraine Women with a uterus need a progestogen in addition to oestrogen: Give cyclical HRT if the LMP was less than one year previously, otherwise a continuous combined preparation is usually indicated. Cont ... Date: 31-07-2019 Categories: • Sexual health • Women's health, gynaecology and obstetrics
Patients to access health information through Amazon Alexa ... y those who cannot access the internet through conventional means. The algorithm from Amazon will use information from the NHS website to answer questions such as: ‘Alexa how do I treat a migraine?’ ‘Alexa what are the symptoms of flu?’. But RCGP chair Helen Stokes-Lampard said it was 'vital' that independent research was done to make sure the advice given is safe. She said: ‘This idea is certain ... Date: 10-07-2019 Categories: • Technology
Menopause and migraine What you should already know Migraine is the third most common chronic disease in the world, affecting an estimated one in seven people. Migraine affects two to three times more women than men, and the difference is mostly hormonally dri ... Date: 27-06-2019 Categories: • Sexual health • Women's health, gynaecology and obstetrics
Light in the LMC conference tunnel ... soul of general practice? Is it the rapid blink of a lighthouse warning us of rocky network service requirements ahead? Is it a red ‘stop’ light? Is it a visual aura warning us of a gigantic migraine? Is it a flashing blue light come, too late, to resuscitate general practice? In fact, Richard, is there really any light at all? I see the tunnel, but I don’t see the light. I don’t know what the aim of thi ... Date: 20-03-2019 Categories: • Copperfield • Uncategorised
How to spot zebras - Behçet’s disease ... vein thrombosis Intracranial sagittal vein thrombosis Large vessel aneurysm (especially pulmonary artery and aortic branch) Migrainous type headache (responding well to standard migraine therapy) Inflammatory CNS disease, typically brainstem Differential diagnosis The key differentials for Behçet’s that must be excluded before the diagnosis can be made include Crohn’s disease (skin, mucosal and bowel fe ... Date: 24-01-2019 Categories: • Dermatology and wound care • Musculoskeletal, rheumatology and sports medicine
How to spot zebras - pheochromocytoma ... ained chest or back pain Hypoglycaemia Temporal lobe epilepsy Angina/IHD Difficult to control diabetes Menopause Heart failure Pre-eclampsia Renovascular disease Migraine Table 1: Non-exhaustive list of potential differential diagnosis where a diagnosis of PPGL should be considered.2 Investigation Advances in biochemistry now make a secretory PPGL relatively easy to rule ou ... Date: 02-01-2019 Categories: • Cancer • Long-term conditions and prescribing
Number of GP patients co-prescribed gabapentinoids and opioids triples ... e gabapentinoid prescriptions are concerning however, pain is complex and we don’t know the reasons for the gabapentin or pregabalin prescriptions (e.g. pain, anxiety, migraine, epilepsy).' 'The key with pain, especially neuropathic pain, is making an accurate diagnosis at the start - there are no assessment guidelines in the NICE neuropathic pain guidelines though others - such as the British Pain Societ ... Date: 05-12-2018 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction
Prepare to be amazed by some evidence-based magic ... of the deceit required. Now it seems the supposed sleight-of-prescribing was real magic all along: you can adopt a policy of complete honesty and still cure all those migraines, IBSs and TATTs. I don’t know whether to laugh or cry. But I do know that I’m thoroughly confused. Would someone who knows about research kindly take a look at this paper with a view to finding enough flaws to allow me to reconven ... Date: 16-10-2018 Categories: • Copperfield • Long-term conditions and prescribing
Royal Colleges urge patients to question GPs over tests and treatments ... , minimal, non-specific, or long-standing urinary symptoms Review the use of antibiotics for conditions that are not infections Not routinely image patients with suspected migraine Not use drug treatments to manage behavioural and psychological problems in patients with dementia if they can be avoided Source: Academy of Royal Medical Colleges Date: 26-06-2018 Categories: • Long-term conditions and prescribing • NHS structures

The only problem with the polypill is that it doesn't go far enough ... with the polypill is that it doesn’t go far enough. If I was in charge of the pestle and mortar, I’d slip in the following: Amitriptyline: my 'Desert Island' drug. It helps insomnia, IBS, migraine, OABs, neuropathy, tension and fibromyalgia, all of which I have by close of play on a Monday. Only a low dose, tragically. Remember when we dished out 150mg/day for depression? Happy days. Literally. SGL ... Date: 12-03-2025 Categories: • Cardiovascular • Copperfield

MHRA opens up for more medicines to become available without a GP prescription More medicines could be switched from prescription-only medicines (POM) to pharmacy medicines (P), as the Medicines and Healthcare Products Regulatory Agency (MHRA) has encouraged medicines manufacturers to ... Date: 11-02-2025 Categories: • Dermatology and wound care • Gastroenterology and obesity • Respiratory • Women's health, gynaecology and obstetrics

The ‘clinic clichés’ that stop us in our tracks ... looking down at the floor as he slowly entered the room. 'My head's banging doc,' he started, grimacing in pain. I could believe he was in the throes of an acute migraine looking at him hunched up in front of me. I soon realised he was very serious about jumping off a bridge that evening. The physical symptoms were exacerbated by his mental state - as is so often the case with our patients - and although ... Date: 24-09-2024 Categories: • Writing Competition 2024

Triptans better than newer more expensive drugs for migraine, say researchers GPs should prescribe more triptans for the treatment of migraines, say researchers who found them to be the most effective option but underused. An extensive study by a team across Europe comparing all treatments found triptans to be more effective than newer m ... Date: 19-09-2024 Categories: • Mental health, pain and addiction

Rise in GP practices participating in research studies ... they wouldn’t otherwise be able to access.’ The health centre supports a mix of commercial and non-commercial studies, including trials that looked into diabetes, flu, RSV, migraines, smoking cessation and more. In total, there were 6,074 CRN-supported studies in England in 2023/24. Around a third of were commercial trials (29%), which are fully funded by the life sciences industry, while 10% were ... Date: 16-08-2024 Categories: • Diabetes and endocrinology

Migraine: Myths and Facts In the first of a new series exploring some common misconceptions about conditions seen in general practice, GP and headache specialist Dr Richard Wood debunks some myths about migraine – and explains some perhaps less well known facts Myths 1. Chocolate and caffeine are common dietary triggers and should be avoided by migraine sufferers While some foods can sometimes be a ... Date: 18-04-2024 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction • Neurology

NICE recommends first oral drug for preventing both chronic and episodic migraines The first oral drug for preventing migraines where other treatments have failed should be available on the NHS, NICE has recommended in final draft guidance. Up to 170,000 people could be eligible for atogepant - also known as Aquipta - und ... Date: 11-04-2024 Categories: • Neurology

Rational referrals: Neurology ... appropriate A&G requested from secondary care when required. Patients and clinicians can be pointed towards online resources such as the British Association for the Study of Headache, the Migraine Trust and the Organisation for the Understanding of Cluster Headache for useful information regarding diagnosis and management. Sensory symptoms. The distribution of isolated sensory symptoms often ... Date: 26-03-2024 Categories: • Mental health, pain and addiction • Neurology

Masterclass: A complete GP’s guide to menopause and perimenopause ... tion, dyspareunia; dysuria, urinary frequency and urgency, and recurrent lower urinary tract infections); reduced libido; sleep disturbance; joint and muscle pains; headaches (including worsening migraine); fatigue. Investigations Do not routinely use follicle-stimulating hormone (FSH) to diagnose perimenopause or menopause in women not using hormonal contraception aged over 45 years with typical me ... Date: 14-03-2024 Categories: • Long-term conditions and prescribing • Women's health, gynaecology and obstetrics

NHS England reiterates call for GPs to curb OTC prescribing NHS England has reiterated guidance asking GPs to limit prescribing of over the counter (OTC) medicines, in a bid to improve 'value for money'. The policy, which was first introduced in 2018, recomm ... Date: 14-03-2024 Categories: • Dermatology and wound care • Long-term conditions and prescribing • Respiratory • Women's health, gynaecology and obstetrics

CPD: Key questions on primary headache disorder GP and headache specialist Dr Richard Wood answers key questions on primary headache disorder, including how to reach a definitive diagnosis of migraine, best management approaches for migraine and tension-type headache and how to recognise and treat other types such as cluster headache Key points Primary headache disorder refers to heada ... Date: 01-03-2024 Categories: • CPD • Long-term conditions and prescribing • Mental health, pain and addiction • Neurology

Supporting autistic patients ... axia, dyslexia, dyscalculia and Tourette’s. Mental health challenges, including disordered eating, depression, anxiety, self-harm and suicidality. Neurological conditions, including epilepsy, migraines, and autonomic dysfunction. Gastrointestinal conditions, including gastric dysmotility and irritable bowel syndrome. Variant connective tissue, including Ehlers Danlos Syndrome and other forms o ... Date: 09-02-2024 Categories: • CPD • Mental health, pain and addiction • Neurology

Clinical Clanger: 'Can I have some more prochlorperazine for my dizziness?’ ... o (BPPV) should be treated with the Epley manoeuvre – medication is ineffective due to the severe and very transient nature of the vertigo in BPPV. Vestibular migraine is much more common that previously realised and the reduction in stressors through regular, good-quality meals and sleep is of much greater importance than medication. The evidenceNICE has guidance on the manag ... Date: 27-10-2023 Categories: • Ear nose and throat and ophthamology • Neurology

Women's health: Menopause and HRT ... ptoms are the most well-known, but symptoms include: low mood, anxiety, reduced self-esteem, poor memory and concentration, reduced libido, joint pains, vaginal dryness, bladder issues, and worsening migraine2. Diagnosis Follicle-stimulating hormone (FSH) testing is not required to confirm the diagnosis of menopause in those aged > 45 if (a) they have vasomotor symptoms and irregular periods (b) ... Date: 22-09-2023 Categories: • Clinical areas • Women's health, gynaecology and obstetrics

NICE to recommend rimegepant as first acute migraine treatment NICE has approved rimegepant as the first treatment for acute migraine, in draft guidance published today. Around 13,000 could benefit from rimegepant (Vydura, Pfizer), said NICE after signing off its use in adults who have tried at least two triptans but they did no ... Date: 14-09-2023 Categories: • Mental health, pain and addiction • Neurology

Red flags in assessing acute vertigo ... Recent or ongoing URTI may predispose to peripheral vertigo, as viral infections can cause vestibular neuritis, labyrinthitis or even induce inner ear inner ear canalithiasis (BPPV). A history of migraines is relevant, as migrainous vertigo or vestibular migraine is more prevalent in clinical practice than commonly believed. Recent head trauma can lead to central vertigo, warranting an urgent asses ... Date: 11-08-2023 Categories: • Neurology

NICE says its new approval process has sped up access to medicines ... load being able to be cut by 25-45%. Medicines that have been through the new faster process include nintedanib for idiopathic pulmonary fibrosis and eptinezumab for treating migraine both of which were eight weeks faster than normal. ‘Those achievements were possible because we worked closely with partners and stakeholders to offer flexible solutions to issues of data and value,’ Dr Roberts said. ... Date: 12-07-2023 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction • Technology

GPs advised to use QRISK3 CVD score for certain patient groups ... has admitted. In a primary care bulletin this week, NHS England said when assessing risk for patients taking corticosteroids or atypical antipsychotics or people with systemic lupus erythematosus, migraine, severe mental illness or erectile dysfunction, GPs should use QRISK3 moving to the online version if needed. Updated cardiovascular disease risk assessment and reduction guidance from NICE recomm ... Date: 08-06-2023 Categories: • Cardiovascular

NICE approves novel oral drug rimegepant for preventing migraine Draft NICE guidance has approved rimegepant, a novel oral drug for preventing migraine, which it said could become available to 145,000 NHS patients. Rimegepant is the first drug of its class to come in pill form, with other similar medications administered as injections. The calcit ... Date: 31-05-2023 Categories: • Mental health, pain and addiction • Neurology

EMIS to continue offering QRisk until next year ... messages. It comes as GP practices are expected to move to routinely using QRisk3, an updated version of the risk score that takes into account other factors including migraine and severe mental illness. In recent updated draft guidance on statins, NICE said QRisk3 performed best in assessing cardiovascular risk in a UK population. The email added: ‘We are awaiting guidance from NHS England on ... Date: 24-03-2023 Categories: • Cardiovascular • Technology

GPs raise workload and safety concerns over loss of QRISK calculator from IT system ... res manual input of the relevant data. It comes as GP practices are expected to move to routinely using QRISK3, an updated version of the risk score that takes into account other factors including migraine and severe mental illness. In recent updated draft guidance on statins, NICE said QRISK3 performed best in assessing cardiovascular risk in a UK population. ‘Until systems are updated with QRIS ... Date: 10-02-2023 Categories: • Cardiovascular • Technology

Clinical clangers: 'My headaches are getting worse, doctor – it must be my blood pressure’ ... on can often be dealt with on the phone. If there are no red flags, and the headache sounds like something benign (for example, a tension headache) or is a flare of a known condition such as migraine, then reassurance and simple advice might be sufficient. Avoid checking the patient’s BP as it is likely to be raised and this risks overdiagnosis of hypertension or unnecessary investigations. Expla ... Date: 13-10-2022 Categories: • Cardiovascular • Mental health, pain and addiction • Neurology

How to consult remotely: headache ... nfident of managing the initial process over the phone or by video, for those patients happy to consult remotely. However, as presentations become more complex, particularly with chronic migraine which can be associated with a number of comorbidities, face-to-face consultations are preferable for identifying important subtle clues and enhancing information gathering and communication. The thre ... Date: 22-06-2022 Categories: • Neurology • Remote consultations

How to consult remotely: contraception ... (BP) and other factors in the Faculty of Reproductive and Sexual Healthcare (FRSH) UK Medical Eligibility Criteria for Contraceptive Use (UK MEC).2 Ensure the patient has no prior history of migraine with aura, and document this. It may be necessary to remotely record weight, body mass index (BMI) and BP for safe prescribing. Patients can self-report these observations with home measurements, or with ... Date: 13-05-2022 Categories: • Long-term conditions and prescribing • Sexual health • Women's health, gynaecology and obstetrics

All the reaction to the NHSE £250m package for general practice ... re admin staff. £250m time-limited which may not actually be extra money is quite frankly an insult. Staff and doctors are burning out here. As I write, I'm at work with a horrible migraine and feel sick. Today's news has made this worse. I'm duty doc this afternoon. If I go off sick with the stress-related migraine, who will call the 15 patients I have booked in? Who will process 100 letters, check 100 r ... Date: 14-10-2021 Categories: • Contract • NHS rescue plan

Preventing access is no way to deal with rising demand ... eed of access are simultaneously failing to get through. There is risk hidden in every waiting list, and that risk increases the longer the waiting list grows. Is a patient’s headache simply a migraine, or is it a subarachnoid haemorrhage? Is the pain in your patient’s stomach something trivial, or acute appendicitis? It is true that some digital health services actively increase the demand for prim ... Date: 02-07-2021 Categories: • Practice life • Pulse PCN

Pregnant women on sodium valproate to be reminded to urgently see GP ... age, unless they are on a pregnancy prevention programme. GPs have also been advised that they must not prescribe valproate for bipolar disorder or migraine and that they must not prescribe the drug for epilepsy unless there is no other effective treatment available. Date: 15-06-2021 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction • Neurology • Women's health, gynaecology and obstetrics

Ten top tips: Headache after AZ Covid vaccination (updated 21 April) ... comfortable reassuring a patient with a headache after vaccination if I can give them a plausible reason for their headache. Does it fit with a flare of pre-existing migraine, tension headache or something else already known? Or is there another reason to be concerned? Meningitis, mastoiditis, intracranial bleeds and tumours haven’t gone away just because we’re all thinking about CSVT. If you can’t fi ... Date: 21-04-2021 Categories: • Covid-19 • Infectious diseases, immunology and allergy • Mental health, pain and addiction • Vaccinations, prevention and screening

Erenumab recommended for some migraine patients under commercial deal NICE has recommended erenumab for treating migraine in some patients after earlier drafts of the guidance were appealed. Patients who have four or more migraine days a month and who have already tried at least three other preventive medicines will ... Date: 10-03-2021 Categories: • Mental health, pain and addiction • Neurology

How to deal remotely with… HRT prescribing ... Key pointers in the history • Are there any contraindications to HRT or reasons to be cautious? Specifically ask about relevant history such as VTE, cardiovascular disease, migraine, breast or ovarian cancer, thyroid or liver/gallbladder disease. • Is she sexually active? Consider her need for contraception. HRT is never contraceptive.8 • A computer template for HRT initiation and repeat prescrib ... Date: 11-02-2021 Categories: • Women's health, gynaecology and obstetrics

Appeal success on NICE guidance on erenumab for preventing migraine NICE is likely to recommend erenumab for preventing migraine later this month (January 2021) after earlier drafts of the guidance were appealed. In final draft guidance, the committee ruled that the treatment would be cost effective in patients who had trie ... Date: 11-01-2021 Categories: • Neurology

NICE recommends new migraine treatment for up to 200,000 patients in the UK NICE has recommended a new treatment for migraine prevention that around 200,000 patients in the UK could be eligible for. Galcanezumab, known as Emgality, is a monthly injected treatment for the prevention of migraine in adults with both chronic ... Date: 19-11-2020 Categories: • Long-term conditions and prescribing • Neurology

Introducing the GP behind the new PulseToday Covid toolkit ... Hospital for Neurology and Neurosurgery, Queen Square and UCLH Mr James Tysome, Consultant ENT Surgeon, Cambridge University Hospitals Dr Marcus Lewis, GPwSI in Headache and Migraine, Camden Dr Dana Beale, Specialist GP and Homeless Health Lead for North West London Dr Siobhan Gee, Principal Pharmacist, Liaison Psychiatry, South London and Maudsley NHS Foundation Trust& ... Date: 16-11-2020 Categories: • Covid-19

NICE issues new draft guidance for 6-8 week GP postnatal check ... problems • persistent or severe headache, which could indicate hypertension, pre eclampsia, postdural-puncture headache, migraine, intracranial pathology or infection. 1.2.5 At each postnatal contact, give the woman the opportunity to talk about her birth experience, and provide information about relevant support services, if appropriate. Source: NICE Date: 21-10-2020 Categories: • Women's health, gynaecology and obstetrics

Non-febrile seizures in a child or young person ... ve epilepsy.1 The misdiagnosis rate of epilepsy in the UK is approximately 30%. Other conditions that can be misdiagnosed as seizures include faints, daydreaming, panic attacks, sleep disturbance, migraine, breath-holding, cardiac abnormalities or non-epileptic attacks (pseudo-seizures). 2 Understand the diagnostic criteria for epilepsy Epilepsy is the commonest significant neurological disorder ... Date: 12-10-2020 Categories: • Paediatrics

Non-Covid clinical crises: Cluster headaches Cluster headaches are frequently misdiagnosed and inadequately managed. The key is to ask patients what they do during an attack. Migraine suffers will want to lie quietly in a darkened room but a patient with cluster headache will be agitated, rock back and forth, and pace the room. Important differences between migraine and cluster h ... Date: 09-04-2020 Categories: • Clinical crises • Neurology

Non-Covid clinical crises: Potential brain tumour ... f directly available and not resolving): new headache where a diagnostic pattern has not emerged after eight weeks from presentation. The majority of headaches presenting to general practice will be migraine. headache aggravated by exertion or Valsalva’s manoeuvre headaches that have been present for some time but have changed significantly (here interpretation may be difficult) new headache in a patient ... Date: 09-04-2020 Categories: • Clinical crises • Neurology

Contraception: How to manage without face-to-face consultations - 19 March ... nurse (if so ask for her latest weight measured on her home scales) • Any change in her medical status (any new medical problems or being investigated for any new medical conditions, including migraine, VTE, hypertension or change to any medication she is taking) • Any change in her family history since she was last seen (e.g new family history of DVT /PE) If a repeat prescription of the combined pill/ ... Date: 06-04-2020 Categories: • Covid-19 resources • Sexual health • Uncategorised

The human connection ... ey can’t hoodwink me into a buy-one-get-one-free consultation, when you hope to squeeze in a one-minute call to explain a test result, but 10 minutes later you’re still hearing about piles, migraines and indigestion. The cardy-wearers may want a 15-minute chat about lifestyle choices, but back on earth we are firefighting so a quick text will do just fine, thanks. But on the whole, the march to tech for t ... Date: 18-02-2020 Categories: • Covid-19 • Nabi

GPs need to be alerted to beta blocker overdose risk, says NHS safety watchdog ... sk of toxicity if the drug is overdosed. The investigation was prompted by the case of a 24-year-old woman who died in 2018 after taking an overdose of propranolol, which she had been prescribed for migraines, and citalopram. She deteriorated rapidly before an ambulance was able to reach her. The report found that propranolol is prescribed widely and generally without clinical incident in primary care, mo ... Date: 06-02-2020 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction

Rage against the migraine A friend of mine phones her surgery. She knows a thing or two about migraines, having suffered from them for years, and just wants an appointment to discuss restarting prophylaxis. No chance. Not for the foreseeable future. Oh. OK then, how about a telephone call from the GP ... Date: 26-11-2019 Categories: • Copperfield • Regulation • Uncategorised

Safe HRT prescribing ... e within 10 years of their menopause onset, it can reduce their future risk of developing osteoporosis, type 2 diabetes, osteoarthritis and all-cause mortality.4-6 More on menopause: menopause and migraine Women with a uterus need a progestogen in addition to oestrogen: Give cyclical HRT if the LMP was less than one year previously, otherwise a continuous combined preparation is usually indicated. Cont ... Date: 31-07-2019 Categories: • Sexual health • Women's health, gynaecology and obstetrics

Patients to access health information through Amazon Alexa ... y those who cannot access the internet through conventional means. The algorithm from Amazon will use information from the NHS website to answer questions such as: ‘Alexa how do I treat a migraine?’ ‘Alexa what are the symptoms of flu?’. But RCGP chair Helen Stokes-Lampard said it was 'vital' that independent research was done to make sure the advice given is safe. She said: ‘This idea is certain ... Date: 10-07-2019 Categories: • Technology

Menopause and migraine What you should already know Migraine is the third most common chronic disease in the world, affecting an estimated one in seven people. Migraine affects two to three times more women than men, and the difference is mostly hormonally dri ... Date: 27-06-2019 Categories: • Sexual health • Women's health, gynaecology and obstetrics

Light in the LMC conference tunnel ... soul of general practice? Is it the rapid blink of a lighthouse warning us of rocky network service requirements ahead? Is it a red ‘stop’ light? Is it a visual aura warning us of a gigantic migraine? Is it a flashing blue light come, too late, to resuscitate general practice? In fact, Richard, is there really any light at all? I see the tunnel, but I don’t see the light. I don’t know what the aim of thi ... Date: 20-03-2019 Categories: • Copperfield • Uncategorised

How to spot zebras - Behçet’s disease ... vein thrombosis Intracranial sagittal vein thrombosis Large vessel aneurysm (especially pulmonary artery and aortic branch) Migrainous type headache (responding well to standard migraine therapy) Inflammatory CNS disease, typically brainstem Differential diagnosis The key differentials for Behçet’s that must be excluded before the diagnosis can be made include Crohn’s disease (skin, mucosal and bowel fe ... Date: 24-01-2019 Categories: • Dermatology and wound care • Musculoskeletal, rheumatology and sports medicine

How to spot zebras - pheochromocytoma ... ained chest or back pain Hypoglycaemia Temporal lobe epilepsy Angina/IHD Difficult to control diabetes Menopause Heart failure Pre-eclampsia Renovascular disease Migraine Table 1: Non-exhaustive list of potential differential diagnosis where a diagnosis of PPGL should be considered.2 Investigation Advances in biochemistry now make a secretory PPGL relatively easy to rule ou ... Date: 02-01-2019 Categories: • Cancer • Long-term conditions and prescribing

Number of GP patients co-prescribed gabapentinoids and opioids triples ... e gabapentinoid prescriptions are concerning however, pain is complex and we don’t know the reasons for the gabapentin or pregabalin prescriptions (e.g. pain, anxiety, migraine, epilepsy).' 'The key with pain, especially neuropathic pain, is making an accurate diagnosis at the start - there are no assessment guidelines in the NICE neuropathic pain guidelines though others - such as the British Pain Societ ... Date: 05-12-2018 Categories: • Long-term conditions and prescribing • Mental health, pain and addiction

Prepare to be amazed by some evidence-based magic ... of the deceit required. Now it seems the supposed sleight-of-prescribing was real magic all along: you can adopt a policy of complete honesty and still cure all those migraines, IBSs and TATTs. I don’t know whether to laugh or cry. But I do know that I’m thoroughly confused. Would someone who knows about research kindly take a look at this paper with a view to finding enough flaws to allow me to reconven ... Date: 16-10-2018 Categories: • Copperfield • Long-term conditions and prescribing

Royal Colleges urge patients to question GPs over tests and treatments ... , minimal, non-specific, or long-standing urinary symptoms Review the use of antibiotics for conditions that are not infections Not routinely image patients with suspected migraine Not use drug treatments to manage behavioural and psychological problems in patients with dementia if they can be avoided Source: Academy of Royal Medical Colleges Date: 26-06-2018 Categories: • Long-term conditions and prescribing • NHS structures

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