Frontiers Journal of Neurology & Neuroscience

Headache Management In The Ambulatory Care Unit At The Royal Lancaster Infirmary


Background: Headaches remain one of the commonest neurological complaints. According to the World Health Organization, about 50% of adults will complain of a headache within the last year1. Despite the figures, only a minority of headaches are appropriately diagnosed and treated by healthcare professionals1, 2. Headaches are known to affect a person's quality of life and financially affect the society3.

Method: In this prospective study, we looked into the current management process of the latest ten patients presenting with a headache at the Ambulatory Care Unit at the Royal Lancaster Infirmary. Scores were attributed to each of those cases according to specific criteria such as completion and documentation of examination findings, blood tests, if a lumbar puncture was done and if neuro-imaging studies were requested or done. A total of 15 points was available per case. Afterwards we used the National Institute of Clinical Excellence (NICE) and British Association of the Study of Headache (BASH) guidelines and created a user - friendly admission clerking pro forma and a headache assessment pathway. Once this was implemented on the unit, the following headache cases (n=11), were scored according to the same set criteria than the pre intervention group.

Lessons learned: Our study showed a 44% increase in the average score attributed to the headache cases (pre intervention = 8.7 v/s post intervention = 12.5). We observed an upward shift of score parameters from (6-11) prior to the intervention compared to (9-14) after the intervention. Fundoscopy was done more routinely and examination findings were better documented.

Conclusion: The study should that implementing a clerking pro forma and an assessment pathway for patients presenting with a headache improved their management plan. Patients were examined more thoroughly and better documentation of examination findings would allow improve follow up plans where required.