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Adherance to Headache Guidelines
EP30720
Poster Title: Adherance to Headache Guidelines
Submitted on 28 Sep 2019
Author(s): Sanna Tahir, Rebecca Wiles
Affiliations: None
This poster was presented at BIR Annual Congress 2019
Poster Views: 268
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Poster Information
Abstract: Headache is one of the most common neurological complaints presenting in general practice. Imaging plays an indispensable role in the diagnosis and management of appropriately selected cases. Regional guidelines state that patients with “red flag” symptoms should be discussed via a dedicated headache telephone line. If imaging is to be performed MRI is advised, not a CT.

Using the radiology information system all CT and MRI scans requested by GPs for the investigation of headache between 1st April - 1st October were reviewed. Scan requests were compared with regional guidelines. 37 scans were excluded as patients had additional history e.g. trauma/malignancy. 197 scans were included.

Only 1/197 scans were discussed via the headache line before imaging. Red flags were present in only 38% (n=55) of CT and 50% (n=24) of MRI requests. 1% (n=2) of CTs and 2% (n=1) of MRIs identified a possible cause of the headache – the MRI and one of the CT scans was on the same patient. Significant alternative pathology wasn’t found on any scan. Further imaging was required in 2% (n=3) of CT and 0% of MRI scans.

Compliance with the regional headache pathway was poor. In particular most GP referrers did not discuss the patient with the neurocentre before requesting imaging and CT was more commonly requested than MRI. This is likely due to lack of knowledge of the protocol amongst GPs and radiologists vetting requests. Changes have since been implemented to vetting protocols to inform GPs of the pathway.
Summary: Compliance with the regional headache pathway needs to be improved. In particular most GP referrers did not discuss the patient with the neurocentre before requesting imaging and CT was more commonly requested than MRI. This is likely due to lack of knowledge of the protocol amongst GPs and radiologists vetting requests. Changes have since been implemented to vetting protocols to inform GPs of the pathway.
References: Holle D, Obermann M ‘The role of neuroimaging in the diagnosis of headache disorder’ Ther Adv Neurol Disorder 2013 Nov; 6( 6): 369-374
NHS Pan Mersey “Headache Pathway (Adults)” Area Prescribing Committee. 2019 June
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