Implementation and evaluation of existing guidelines on the use of neurophysiological tests in non-acute migraine patients: a questionnaire survey of neurologists and primary care physicians

Headache from the doctors' perspective

BACKGROUND

General practitioners (GPs) and neurologists are involved in treating headache patients in Portugal. Having migraine themselves might influence the way they perceive and treat migraine patients.

OBJECTIVE

To identify clinicians' perceptions about migraine, their own headache status and management of their own migraine.

METHODS

An observational cross-sectional survey of GPs and neurologists using anonymous questionnaires including demographic data, headache and migraine status and migraine perception questions.

RESULTS

Of 348 respondent physicians, 20% were neurologists and 53% were females with an average age of 48 years. The majority had an interest in migraine and considered it disabling (93%), although 65-85% reported management difficulties, GPs more often than neurologists. Satisfaction with current treatment options was high (69-79%). 63 physicians suffered from migraine and 81% felt it influenced their perception of the disease. Portuguese physicians preferentially treat their own migraines with NSAIDs (33%), analgesics (29%) and triptans (20%).

CONCLUSION

Portuguese physicians treating migraine patients have realistic perceptions about the disease and those with migraine feel their perception is influenced by their experience. Although reporting management difficulties, the majority of physicians are satisfied with current treatment options for migraine.

An investigation of factors that influence general practitioners' referral of computed tomography scans in patients with headache

AIM

In assessing patients with headaches, general practitioners (GPs) play an important role in determining which patients require computed tomography (CT) scans. The purpose of this study was to identify factors that influence GPs' decisions to refer CT scans for patients with headaches.

MATERIALS AND METHODS

A self-administered survey was presented to GPs in Western Australia. One hundred and twenty-eight vignettes describing patients who may have required CT referral for headache were constructed encompassing six clinical variables. Nine vignettes, selected at random, were presented to each respondent. Respondents were asked if they would refer the patient for diagnostic imaging tests, if so, which imaging modalities would they request, how urgently and the perceived benefits of the requested imaging modality. Multinomial logistic regression was used for the multivariate analysis.

RESULTS

We received 105 completed questionnaires (21%). GPs were more likely to refer patients with headaches for diagnostic imaging and CT scans in the following clinical scenarios: patients with a history of colorectal cancer and epilepsy; and patients feeling unwell for the past 6 weeks and headache being exacerbated with valsalva manoeuvrers. Private health insurance and other respondent demographics such as GPs experience and site of care increased imaging referral.

CONCLUSION

GP's referral decisions of diagnostic imaging and CT examinations for patients with headaches are dependent on clinical scenarios and the likelihood of a significant pathology. Further research is required to identify the significant clinical findings with regard to the CT referrals and ensure that CT scans are not requested in patients who are unlikely to benefit.