Introduction: Doctors in primary care are responsible for diagnosing and managing patients with headache, but frequently lack confidence in
doing so. We aimed to compare Family Practitioners’ (FPs) diagnosis of headaches to classification based on a symptom questionnaire, and to
describe how classification links to other important clinical features.
Methods: This was an observational study of patients attending primary care doctors for headache.
Results: 255 patients completed questionnaires. There was low agreement between FP diagnosis and classification using the symptom
questionnaire. FPs frequently did not use the diagnosis migraine, when patient reported symptoms which justified this. FPs did not classify patients
with ≥15 days of headache separately as chronic daily headache (CDH), and this could be because the classification system used does not have that
code. Patients classified as CDH using the symptom questionnaire reported more disability, more symptoms of anxiety and depression (HADS),
more service use, and less satisfaction with FP care.
Main outcome measures: Patients completed a questionnaire including the Headache Impact Test, the Migraine Disability Assessment Score,
the Hospital Anxiety and Depression Scale, the Illness Perceptions Questionnaire, a satisfaction scale, a service use inventory and a symptom
questionnaire rated by two Practitioners with Special Interest (PSIs) in Headache.
Conclusion: Patients, who present with headache in primary care, tend to receive non-specific diagnoses. Having a system that would allow
separate classification of people with headache of ≥ 5 days a month might help FPs to explore and address associated features with patients in terms of
disability, psychological co-morbidity and cost, and improve satisfaction with care.
Original languageEnglish
JournalJournal of Neurology and Neurosurgery
Issue number1
Publication statusPublished - 2014


  • Primary care


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