Headache and migraine in primary care: consultation, prescription, and referral rates in a large population

Abstract

Background/Aims: Headache is the most common new neurological symptom seen by general practitioners and neurologists. This study describes headache consultation, prescription, and referral rates in a large sample of UK general practices. Methods: Analysis of data from patients >15 years registered at 253 UK general practices diagnosed with headache/migraine from 1992 to 2000. Rates were age standardised using the European standard population for reference.Results: There were 13.2 million patient years of observation. Headache consultation rates were 6.4/100 patients/ year in women and 2.5 in men. They were highest at 15-24 years (15.8/100 in women; 5.8/100 in men), decreasing with age. Antimigraine drugs were prescribed at 36.7% of consultations for women and 26.6% for men. Among referrals to specialists, 55% were to neurology and 30% to general medicine. The neurology referral rate in patients with headache was 2.1/100, and was higher in men (2.7/100) than women (1.9/100). Conclusions: These results provide precise age specific and age standardised estimates for headache consulting in general practice, in addition to prescribing and referral to specialist care. Consultation rates are highest in young women; hospital referrals peak in middle aged men. Research is needed into reasons for referral, and on better ways of delivering headache services.

Diagnosing headache in primary care: a qualitative study of GPs’ approaches

“…Headache is one of the most common symptoms in primary care [1][2][3] and can lead to relevant reduction of health-related quality of life for the individual patient. 4 Most patients experience primary headaches which includes, according to the International Classification of Headache Disorders (ICHD), migraine, tension-type headache, trigeminal autonomic cephalgias, and other primary headache disorders.…”

“…5 Patients with headache reflect a broad spectrum of symptom frequency and severity and the vast majority of patients is managed in the primary care setting. 2,6,7 There are conflicting views on the importance of an exact diagnosis in patients with headache. While it is stressed that headache treatment needs to be tailored to an exact diagnosis 8 and several authors see knowledge deficits in GPs concerning the diagnosis and management of headache, 9,10 others question the relevance of an exact diagnosis in the primary care setting as in most patients headache is of benign and selflimiting origin.…”

The assessment of headaches on the acute medical unit: is it adequate and how could it be improved?

“…Unfortunately, no GP trainees responded to the questionnaire, which is disappointing as headache is an important neurological presentation in primary care. 26 The sample sizes of the audit and re-audit were both small, gathered a limited set of data and consultant review was not blinded to pre-or post-guideline status.…”

Should GPs have direct access to neuroradiological investigation when adults present with headache?

“…9 Although only 3% of headache consultations are referred to secondary care, 9 headache is the most common cause of neurological referral, accounting for over 20% of new cases. 10 There is no difference in headache impact between neurology headache referrals and patients managed in primary care, but patients who are referred consult more frequently and have higher levels of headache-related anxiety.…”