Headache in the neurology clinic: a 2-year audit
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ORIGINAL ARTICLE
Headache in the neurology clinic: a 2-year audit Kinley Roberts 1
&
Linda Harrington 1 & Sinéad M. Murphy 1,2
Received: 23 June 2020 / Accepted: 17 October 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Headache is the most common reason for referral to neurology outpatient clinics in Ireland and represents approximately 30% of all new appointments. Aim To evaluate diagnoses and outcomes of all patients newly referred with headache to a consultant neurologist at an Irish university teaching hospital over a 2-year period. Design A retrospective analysis and audit. Methods Data including patient demographics, red flags, investigations, diagnosis, and outcome were collected on consecutive patients newly referred with headache to a consultant neurologist’s outpatient clinic over a 2-year period. Results Two hundred and seventy patients with headache were seen; 75% were women with mean age of 39 years. 89.26% (241/ 270) were diagnosed with a primary headache disorder alone; 4.44% (12/270) with a secondary headache disorder alone; 3.33% (9/270) with both a primary and secondary headache disorders; and 2.96% (8/270) with a painful cranial neuropathy. Migraine was the most common diagnosis, frequently associated with medication overuse. Non-attendance rates were high. Although imaging abnormalities were frequently found, on no occasion was it thought to be the cause of the headache. Conclusions Most patients referred to a neurology outpatient clinic with headache have a primary headache disorder. Alternate pathways should be considered to reduce the burden on Ireland’s limited neurology resources without compromising patient safety. Keywords Headache . Migraine . Neurology . Outpatient . Referral
Introduction Headache represents nearly 50% of the worldwide neurological disability burden, with migraine alone being the second most disabling disease overall, but particularly among women [1]. Most sufferers are of working age and therefore, the socioeconomic impact is huge [2]. The annual UK cost of referring patients with migraine to specialist clinics is estimated to be over 800 million pounds [3] and headache costs the Irish Exchequer €290 million each year [4]. Headache is the most common neurological condition presenting to general practitioners (GPs) [5]. Recently published
* Kinley Roberts [email protected] 1
Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland
2
Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
American and European guidelines are readily available to help diagnose and manage common headache disorders in the primary care setting, and to recognize “red flags” that indicate a need for investigation or tertiary referral [6–8]. Despite this, at least a quarter of all new referrals to specialist neurology outpatient services are for headache [9–12]. Neurologists, as a result, have reduced opportunities to see new referrals relating to other neurological conditions [13]. In addition, the Republic of Ireland has one o
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