How do patients referred to neurologists for headache differ from those managed in primary care?

Headache is the neurological symptom most frequently presented to GPs and referred to neurologists, but little is known about how referred patients differ from patients managed by GPs.

Aim

To describe and compare headache patients managed in primary care with those referred to neurologists.

Design of study

Prospective study.

Setting

Eighteen general practices in south-east England.

Method

This study examined 488 eligible patients consulting GPs with primary headache over 7 weeks and 81 patients referred to neurologists over 1 year. Headache disability was measured by the Migraine Disability Assessment Score, headache impact by the Headache Impact Test, emotional distress by the Hospital Anxiety and Depression Scale and illness perception was assessed using the illness perception questionnaire.

Results

Participants were 303 patients who agreed to participate. Both groups reported severe disability and very severe impact on functioning. Referred patients consulted more frequently than those not referred in the 3 months before referral (P=0.003). There was no significant difference between GP-managed and referred groups in mean headache disability, impact, anxiety, depression, or satisfaction with care. The referred group were more likely to link an increased number of symptoms to their headaches (P=0.01), to have stronger emotional representations of their headaches (P=0.006), to worry more (P=0.001), and were made anxious by their headache symptoms (P=0.044).

Conclusion

Patients who consult for headache experience severe disability and impact, and up to a third report anxiety and/or depression. Referral is not related to clinical severity of headaches, but is associated with higher consultation frequency and patients' anxiety and concern about their headache symptoms.