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Davies PTG, Lane RJM, Astbury T, et al. The long and winding road: the journey taken by headache sufferers in search of help. Prim Health Care Res Dev. 2018;20:e4doi: 10.1017/S1463423618000324.
Davies, P. T. G., Lane, R. J. M., Astbury, T., Fontebasso, M., Murphy, J., & Matharu, M. (2019). The long and winding road: the journey taken by headache sufferers in search of help. Primary health care research & development, 20e4. https://doi.org/10.1017/S1463423618000324
Davies, Paul T G, et al. "The long and winding road: the journey taken by headache sufferers in search of help." Primary health care research & development vol. 20 (2019): e4. doi: https://doi.org/10.1017/S1463423618000324
Davies PTG, Lane RJM, Astbury T, Fontebasso M, Murphy J, Matharu M. The long and winding road: the journey taken by headache sufferers in search of help. Prim Health Care Res Dev. 2019 Jan;20:e4. doi: 10.1017/S1463423618000324. Epub 2018 May 31. PMID: 29848391; PMCID: PMC6476391.
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Prim Health Care Res Dev. 2019 Jan;20:e4. doi: 10.1017/S1463423618000324. Epub 2018 May 31.

The long and winding road: the journey taken by headache sufferers in search of help.

Primary health care research & development

Paul T G Davies, Russell J M Lane, Theresa Astbury, Manuela Fontebasso, Jill Murphy, Manjit Matharu

Affiliations

  1. 1Department of Neurology,Northampton General Hospital,Billing Road,Northampton,UK.
  2. 4Department of Neurology,Ashford Hospital,Middlesex,UK.
  3. 5York Headache Clinic (York District Hospital),York,UK.
  4. 6The London Headache Group,National Hospital for Neurology and Neurosurgery,Queen Square,London,UK.

PMID: 29848391 PMCID: PMC6476391 DOI: 10.1017/S1463423618000324

Abstract

AimTo outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care. BACKGROUND: At first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are 'chronic migraine' and 'medication overuse headache'. They are either no better or worse than when their headaches first started despite their efforts. METHOD: We undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients' headache characteristics, the 'burden' of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried.FindingsMost patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care.

Keywords: chronic migraine; headache clinic; headache management; headache pathway; medication overuse headache

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