The impact of an online adult headache guideline on headache referrals to the neurology clinic

Abstract

Background Headache is a common problem in primary care and one of the main reasons general practitioners (GP) consult the neurology service. We developed an online adult headache guideline (Supporting Information Appendix S1) for the greater Wellington Region as a resource for GP to guide identification of concerning headaches, initiation of prophylactic medications for migraine and management of analgesic overuse headache. Aims To examine the effectiveness of this adult headache guideline in reducing demand on the neurology outpatient service for headache patients that could readily be managed in primary care. Methods We reviewed electronic referrals to Wellington Hospital's neurology department before and after the implementation of the online headache guideline. The primary outcome was the proportion of referrals for headache. Secondary outcomes included proportion of referrals requiring clinic review, rate of pre‐referral trial of headache prophylactic medication and medication overuse headache diagnosed at neurological consultation. Results Nine hundred neurology referrals before and 801 referrals after the publication of the online headache guideline were included. There was a statistically significant reduction in proportion of referrals for headache (15.4% vs 11.7%; P = 0.026). There was neither an increased rate of pre‐referral adequate prophylactic medication trial (33.8% vs 27.7%; P = 0.320) nor fewer medication overuse headaches diagnosed during the neurology assessment (21.9% vs 25.0%; P = 0.674). Conclusion The launch of an online headache guideline was associated with a reduction in demand on neurology service. Further education could improve the utilisation of this guideline, to avoid delays in prophylactic treatment and reduce the harm of medication overuse.

Headache education by leaflet distribution during COVID‐19 vaccination and school‐based on‐demand e‐learning: Itoigawa Geopark Headache Awareness Campaign

“…With the introduction of new drugs such as calcitonin gene–related peptide blockers, 28,29 its receptor blocker, 30 ditan, 31 and gepant, 32 pharmaceutical companies are actively engaged in educational activities for medical professionals and patients. Online or onsite intensive educational courses 23,33 for general clinicians have also been held. Awareness campaigns for the general public were also performed 13,23,24 .…”

Identifying variation in GP referral rates: an observational study of outpatient headache referrals

“…[23] Most recently Huang et al found that an online headache referral guideline for GPs was successful in reducing the number of referrals to neurology services. [24] This study also raised the important point that their positive results may be due to both the accessibility of the guideline and the awareness of GPs to its existence.…”

Headache Education for General Public by Leaflets Distribution During COVID-19 Vaccination and School-Based On-demand E-learning in Japanese One City -Itoigawa Geopark Headache Awareness Campaign-

“…With the introduction of new drugs such as calcitonin gene-related peptide blocker [27,28], its receptor blocker [29], ditan [30], and gepant [31], pharmaceutical companies are actively engaged in educational activities for medical professionals and patients. Online or onsite intensive educational courses [23,32] for general clinicians have also been held. The awareness campaigns for the general public were also performed [14,22,23].…”