How do clinicians think about cluster headache

Background: We have little in-depth understanding of how clinicians perceive cluster headache and of their experiences with cluster headache patients.

Aim: In this interdisciplinary study we aim to bridge neurology and sociology of health by gaining insight into the perceptions, experiences and understandings of cluster headache. We focus here on data collected in the north of England.

Method: Qualitative study using semi-structured interviews with general practitioners (n = 8) and neurologists (n = 8). This included 10 male and 6 female clinicians with an average age of 49. All clinicians were interviewed by a health sociologist between March and December 2015. A systematic qualitative analysis was applied to the transcribed interviews.

Result: The following overarching themes emerged after analysis: (1) perceptions of primary headache disorders; (2) challenges with diagnosis; (3) communication between primary and secondary care and (4) effective treatment and management of cluster headaches. We identified specific barriers to early diagnosis of cluster headache and effective treatment pathways for cluster headache patients. For instance, some GPs found it challenging to take an effective history and could often not distinguish key differences between migraine and cluster headache. Neurologists regularly experienced that their suggested treatments, often around sumatriptan injections, were not followed through when patients were referred back to primary care.

Conclusion: This research contributes to our understanding of professional responses to cluster headache. This could form the starting point for the development of interventions to increase early diagnosis in primary care, optimize referrals to specialist care and improve communication between primary and secondary care.