Cluster Headache Often Misdiagnosed and Mismanaged

Dawn O'Shea

June 03, 2020

Tensions exist between primary and secondary care around prescribing treatments for patients with cluster headache (CH), the Cluster Headache: Impact and Perception Study (CHIPS) has found.

CHIPS aimed to explore the perceptions, experiences and understandings of cluster headache among GPs (n=8) and neurologists (n=8) in the north of England.

Four main themes were identified:

  • challenges with diagnosis,

  • impact of cluster headache,

  • challenges with prescribing, 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.

However, the findings, published in the  British Journal of General Practice, reveal tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens.

Some GPs voiced dissatisfaction with the administrative work that comes with prescribing certain treatments being transferred from secondary to primary care. Others suggested transferring the responsibility for prescribing to primary care also meant transferring the cost away from the hospital.

For both GPs and neurologists, prescribing oxygen was challenging because they were often not aware of prescription practices. Some GPs were not aware that oxygen was recommended as an abortive medication for CH. Those who did know were often not familiar with the oxygen prescription policies.

Neurologists thought that a lack of awareness of mixed headache syndromes in primary care contributes to misdiagnosis. They also complained of poor history taking by GPs, resulting in short clinic letters.

The authors say NHS commissioning policies appear to be causing a divide between primary and secondary care and are driving competition for resources. “Clear prescribing responsibilities could avoid the tensions and improve the interface between primary and secondary care,” they say.

Buture A, Ahmed F, Mehta Y, Paemeleire K, Goadsby PJ, Dikomitis L. Perceptions, experiences, and understandings of cluster headache among GPs and neurologists. Br J Gen Pract. 2020 Jun 1 [Epub ahead or print]. doi: 10.3399/bjgp20X710417.  View abstract 

This article originally appeared on Univadis, part of the Medscape Professional Network.

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