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Surfing for headache
  1. N Giffin
  1. Royal United Hospital, Bath n.giffin{at}ion.ucl.ac.uk

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    Web sites for headache vary tremendously in their usefulness to physician and patient. There are those set up by national and international organisations aimed at the clinician and concerned with the structure and organisation of the relevant organisation and management issues. These include the site for the British Association for the Study of Headache (BASH) (http://www.bash.org.uk/), the most useful section of which is probably the British migraine management guidelines. The US equivalent, the site of the American Headache Society (http://www.ahsnet.org/), is more comprehensive with links to useful topics on migraine management. The International Headache Society site (http://www.i-h-s.org/) is aimed particularly at those in clinical headache research with guidelines for drug trials and notice of meetings, but does have some sections of practical use, notably that on recommendations on the risk of stroke in women on the oral contraceptive pill and hormone replacement therapy. The American Academy of Neurology has produced a less dry format and a reasonable headache section aimed more at the patient than physician (http://www.aan.com/), although some advice to patients is somewhat at odds with current thinking—for example, the advice on avoidance of cheese.

    For an update on research for the clinician and patient the Institute of Neurology Headache group web site is worth a visit (http://www.ion.bpmf.ac.uk/~headache/headache.html).

    It is of no surprise that such a prevalent condition with active patient support groups has generated many patient centred sites. The British sites of note are those of the Migraine Trust (http://www.migrainetrust.org/) and Migraine Action (http://www.migraine.org.uk/). The former is easy to navigate, management centred, emphasising what patients can do to help themselves, including migraine and drug diary cards. The information is by and large accurate and clear cut and probably more up to date than some US sites. The Migraine Action site has detailed and accurate information for the patient who wants to know a bit more and take greater responsibility for their own care. However, I couldn’t get some sections of the site to work correctly and many sections are only available to members. The American Council for Headache Education site (http://www.achenet.org/) is easy to navigate and full of useful resources including an interesting migraine art museum. It is particularly good for women and migraine with advice on pregnancy and contraception. The World Headache Alliance site (http://www.w-h-a.org/wha/index.asp) is not as user friendly, but has links to migraine research articles that may be of interest to the patient.

    Cluster headache patients tend to be more proactive in patient support groups and interested in research, a reflection no doubt of the severity of the condition and lack of information offered by the medical community. This is reflected in their websites that generally provide much needed support and advice for sufferers and their supporters. The British site for OUCH (uk) (Organization for the Understanding of Cluster Headache) is at http://www.clusterheadaches.org.uk/. This is for patients and operated by patients, offering excellent support for the cluster headache sufferer who often feels abandoned and misunderstood with this terrible condition, including rather poignantly a link to The Samaritans web site. Other useful topics include those on prophylactic medication, an update on current research and, of practical value, details of how to obtain an oxygen regulator through the OUCH loan scheme. The best US cluster headache site is http://www.clusterheadaches.com/. This is a comprehensive site with detailed (and referenced) treatment information, although a notable omission is the optimal use of verapamil. For the medic, the stunning personal experiences of cluster attacks on this site are an invaluable insight into the pain that our patients experience. There is a chat room for sufferers and many useful links for the patient to other cluster sites.

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