Diagnostic Strategies in Headache Patients Seen in Primary Care – a Qualitative Study
DOI: 10.3238/zfa.2014.0303-0309german translation / full article
Background: Headache belongs to the most common symptoms in primary care. Most headaches are due to primary headaches and many headache sufferers do not receive a specific diagnosis. We aimed to analyse how family doctors (FPs) approach patients presenting with headache.
Method: Interviews with 15 FPs (20–40 min) from urban and rural areas were conducted using a semi-structured interview-guideline. FPs described their individual diagnostic strategies of patients presenting with headache they had prospectively identified during the previous four weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.
Results: The medical history plays a key role in the diagnostic work up of headache patients; the physical examination is of secondary importance. While migraine diagnosis is mainly based on the accumulation of different criteria from patient history, the diagnosis tension type headache is mainly based on presumed pain etiology and pain localization. The differentiation of headache due to neck disorders from tension type headache was discussed controversially. Existing guidelines were not used for diagnosis.
Conclusion: Existing headache guidelines are too complex and not used in daily practice. This underlines the importance to develop guidelines especially adapted for the primary care context.