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Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: A qualitative study

Buture, A., Ahmed, F., Mehta, Y., Paemeleire, K., Goadsby, P.J., Dikomitis, Lisa (2020) Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: A qualitative study. British Journal of General Practice, 70 (696). E514-E522. ISSN 0960-1643. (doi:10.3399/bjgp20X710417) (KAR id:98458)


Background Cluster headache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain, ipsilateral cranial autonomic features, and a tendency to circadian and circannual periodicity. Aim To explore the perceptions, experiences, and understandings of cluster headache among GPs and neurologists. Design and setting Qualitative interview study in primary care surgeries and neurology departments in the north of England. Method Semi-structured interviews were conducted with GPs and neurologists, recorded, and transcribed. A thematic analysis was applied to the dataset. Results Sixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the cluster headache diagnosis; impact of cluster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians recognised the delays in the diagnosis of cluster headache, misdiagnosis, and mismanagement, and were aware of the potential impact cluster headache can have on patients' mental health and ability to remain in employment. Findings highlighted tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens. Patients' anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals. Conclusion Clinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of cluster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs.

Item Type: Article
DOI/Identification number: 10.3399/bjgp20X710417
Uncontrolled keywords: Diagnostic delay, Doctor-to-doctor communication, General practice, Prescribing, Secondary care, adult, Article, clinical feature, clinical practice, cluster headache, drug cost, female, general practitioner, health care cost, human, male, mental health, neurologist, patient attitude, patient referral, perception, personal experience, practice guideline, prescription, primary medical care, professional knowledge, program appropriateness, qualitative analysis, secondary health care, semi structured interview, thematic analysis, cluster headache, England, neurologist, perception, qualitative research, Cluster Headache, England, Humans, Neurologists, Perception, Qualitative Research
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Depositing User: Manfred Gschwandtner
Date Deposited: 30 Nov 2022 17:34 UTC
Last Modified: 06 Dec 2022 09:47 UTC
Resource URI: (The current URI for this page, for reference purposes)

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