A reminder of 'Do no harm' principle

Primum non nocere - "first, do no harm" - is a fundamental principle of the practice of medicine which we doctors need to remind ourselves of from time to time. When adding to our database of links to clinical guidelines over the last few weeks, the NICE guideline published last week on headaches reminded me of this. Although the guideline is a substantive work which covers all aspects of the major causes of headache - tension, migraine, cluster and medication overuse - the headline that screamed out from the BBC news website to report the release of this guideline was: 'Painkillers are the cause of millions of headaches'.

Yes, the headline news was that medicines intended to treat a condition actually made it worse for millions of people! Sarah Jarvis picked up on this in her blog. Although medication-overuse headache has been know about for a long time, it is a timely reminder to us health professionals to be aware of it, and not to contribute to this very common condition.

When I practised as a GP, for me a simple rule of thumb was "anyone who presents with chronic recurring headaches has medication-overuse headache until proved otherwise". I can think of at least three patients over the years who I picked up as having medication-overuse headache, with this simple rule. And, after a fair bit of persuading, stopping their painkillers for a while made a huge difference to their subsequent quality of life.

As usual, we will endeavour to reflect the content of this and other recently published guidelines in our medical articles. Other recently published guidelines added to our database of links other than NICE ones include:

Management of Valvular Heart Disease, European Society of Cardiology (2012)
Guidelines for the management of work-related asthma, European Respiratory Society (2012)
Guidelines on Penile Curvature, European Association of Urology (2012)
Guidelines on the Management of Male Lower Urinary Tract Symptoms, European Association of Urology (2012)
Pressure Ulcers - Good Practice Guide, British Geriatrics Society (2012)

What are your thoughts about this NICE guideline and any other recently-published guidelines? Have your say.


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