J Pascual1, A Sánchez-Escudero, J Castillo. 1. Centro Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España. juliopascual@telefonica.net
Abstract
BACKGROUND AND OBJECTIVE: Headache in general, and migraine in particular, are the main reasons for general practitioners (GPs) to consult neurology services. Our aim was to analyse the current knowledge of GPs in migraine diagnosis. PATIENTS AND METHOD: Unselected GPs from two provinces in Spain were asked to diagnose and treat a fictitious clinical patient who met all International Headache Society criteria for a diagnosis of migraine without aura (5-6 episodes/month), with the only difficulty of a bilateral pain location. The test was anonymous and was given with no previous advice. They were asked to answer in 5-10 min to mimic normal clinical practice. RESULTS: Of the 105 GPs who were consulted, 46 (44%) diagnosed migraine correctly, 41 (39%) diagnosed the patient as tension-type headache, 17 (16%) as "mixed" headache and one GP was unable to diagnose the patient. With only two exceptions, all recommended NSAIDs as symptomatic treatment. Triptans were recommended by 67 GPs (including 15 out of the 41 who had diagnosed the patient as tension-type headache). Preventive treatment was not considered by 30 GPs. A total of 66 GPs would prescribe beta-blockers (13 out of the 41 giving the diagnosis of tension-type headache), 35 amitriptyline (23 of those who had diagnosed as tension-type headache) and the remaining 9 other treatments. CONCLUSIONS: More than half of the GPs made diagnostic mistakes and more than one-third treatment mistakes. In conclusion, there is a need for better teaching in primary headaches and specifically in the diagnosis and treatment of migraine, the primary reason for neurological consultation by GPs.
BACKGROUND AND OBJECTIVE:Headache in general, and migraine in particular, are the main reasons for general practitioners (GPs) to consult neurology services. Our aim was to analyse the current knowledge of GPs in migraine diagnosis. PATIENTS AND METHOD: Unselected GPs from two provinces in Spain were asked to diagnose and treat a fictitious clinical patient who met all International Headache Society criteria for a diagnosis of migraine without aura (5-6 episodes/month), with the only difficulty of a bilateral pain location. The test was anonymous and was given with no previous advice. They were asked to answer in 5-10 min to mimic normal clinical practice. RESULTS: Of the 105 GPs who were consulted, 46 (44%) diagnosed migraine correctly, 41 (39%) diagnosed the patient as tension-type headache, 17 (16%) as "mixed" headache and one GP was unable to diagnose the patient. With only two exceptions, all recommended NSAIDs as symptomatic treatment. Triptans were recommended by 67 GPs (including 15 out of the 41 who had diagnosed the patient as tension-type headache). Preventive treatment was not considered by 30 GPs. A total of 66 GPs would prescribe beta-blockers (13 out of the 41 giving the diagnosis of tension-type headache), 35 amitriptyline (23 of those who had diagnosed as tension-type headache) and the remaining 9 other treatments. CONCLUSIONS: More than half of the GPs made diagnostic mistakes and more than one-third treatment mistakes. In conclusion, there is a need for better teaching in primary headaches and specifically in the diagnosis and treatment of migraine, the primary reason for neurological consultation by GPs.