Survey to evaluate diagnosis and management of headache in primary care: Headache Management Pattern programme.

Objective: The Headache Management Pattern (HMP) programme was designed to evaluate the current clinical situation regarding the diagnosis, treatment and referral of headache in a European primary care setting.
Design and Methods: A total of 705 GPs (from Germany, Portugal and Belgium), who regularly treated migraine patients, completed a questionnaire relating to four different case scenarios described in terms of symptoms, signs and medical history. Each GP completed clinical decision-trees which were created following IHS diagnostic criteria and published treatment guidelines.
Results: Of those questioned, 90% accurately diagnosed a new migraine case and 54% prescribed early intervention with a triptan. However, 23.7% prescribed an NSAID, despite a past history of failed headache relief, and 7.2% indicated that they would refer their patients to a specialist. In the case of a patient whose migraine was deteriorating, 55% of GPs counselled early intervention with a triptan. For chronic migraine sufferers, 42.6% of GPs chose to refer them to a specialist, whilst about one-third made appropriate adjustments to the patient's treatment. The final case, tension-type headache, proved the most difficult scenario to assess, with only 26% of those questioned reaching an adequate diagnosis. Between-country differences in clinical practice may result from local reimbursement policy, treatment guidelines, and different healthcare systems/facilities (e.g., access to specialised care)--all of which could influence the results obtained.
Conclusions: A questionnaire such as the HMP programme inherently has limited depth, and the sampling procedure (GPs with triptan knowledge from three countries) needs to be considered when interpreting the results. Nevertheless, the survey provides important information relating to the management of headache in primary care, highlighting the need for both continuing medical education and also improved referral to specialist care.