TY - JOUR
T1 - Perceptions, experiences, and understandings of cluster headache among GPs and neurologists
T2 - A qualitative study
AU - Buture, A.
AU - Ahmed, F.
AU - Mehta, Y.
AU - Paemeleire, K.
AU - Goadsby, P. J.
AU - Dikomitis, L.
N1 - Funding Information:
The Cluster Headache: Impact and Perceptions Study (CHIPS) was funded by a grant from the Headache Research Trial Fund at the Hull University Teaching Hospitals NHS Trust (ref: YAL094), which was awarded to Lisa Dikomitis, then employed at the University of Hull, now at Keele University.
Publisher Copyright:
© British Journal of General Practice This is the full-length article (published online 2 Jun 2020) of an abridged version published in print. Cite this version as: Br J Gen Pract 2020;
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - 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.
AB - 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.
KW - Diagnostic delay
KW - Doctor-to-doctor communication
KW - General practice
KW - Prescribing
KW - Secondary care
UR - http://www.scopus.com/inward/record.url?scp=85087110973&partnerID=8YFLogxK
U2 - 10.3399/bjgp20X710417
DO - 10.3399/bjgp20X710417
M3 - Article
C2 - 32482627
AN - SCOPUS:85087110973
SN - 0960-1643
VL - 70
SP - E514-E522
JO - British Journal of General Practice
JF - British Journal of General Practice
IS - 696
ER -