Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep;64(626):e532-7.
doi: 10.3399/bjgp14X681325.

Diagnosing headache in primary care: a qualitative study of GPs' approaches

Stefan Bösner  1 , Simone Hartel  1 , Judith Diederich  1 , Erika Baum  1
Affiliations

Diagnosing headache in primary care: a qualitative study of GPs' approaches

Stefan Bösner et al. Br J Gen Pract. 2014 Sep.

Abstract

Background: Headache is one of the most common symptoms in primary care. Most headaches are due to primary headaches and many headache sufferers do not receive a specific diagnosis. There is still a gap in research on how GPs diagnose and treat patients with headache.

Aim: To identify GPs' diagnostic approaches in patients presenting with headache.

Design and setting: Qualitative study with 15 GPs in urban and rural practices.

Method: Interviews (20-40 minutes) were conducted using a semi-structured interview guideline. GPs described their individual diagnostic strategies by means of patients presenting with headache that they had prospectively identified during the previous 4 weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.

Results: Regarding GPs' general diagnostic approach to patients with headache, four broad themes emerged during the interviews: 'knowing the patient and their background', 'first impression during consultation', 'intuition and personal experience' and 'application of the test of time'. Four further themes were identified regarding the management of diagnostic uncertainty: 'identification of red flags', 'use of the familiarity heuristic', 'therapeutic trial', and 'triggers for patient referral'.

Conclusion: GPs apply different strategies in the early diagnostic phase when managing patients with headache. Identification of potential adverse outcomes accompanied by other strategies for handling uncertainty seem to be more important than an exact diagnosis. Established guidelines do not play a role in the diagnostic workup.

Keywords: diagnosis; general practice; headache; qualitative research.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Different red flags for headache mentioned by GPs.
Figure 2.
Figure 2.
GPs’ approaches to use of therapy for diagnostic purposes in patients presenting with headache. The first row shows the different strategies applied by GPs; the arrows indicate whether the patient shows a positive or negative response to it. Boxes in the second row show the resulting diagnostic conclusions of the next steps taken by GPs.
Figure 3.
Figure 3.
Indications for specialist referral in patients with headache.
See this image and copyright information in PMC

References

    1. Morrell DC. Symptom interpretation in general practice. J R Coll Gen Pract. 1972;22(118):297–309. - PMC - PubMed
    1. Latinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurol Neurosurg Psychiatry. 2006;77(3):385–387. - PMC - PubMed
    1. Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: headache. Can Fam Physician. 2007;53(10):1733. - PMC - PubMed
    1. Solomon GD, Skobieranda FG, Gragg LA. Quality of life and well-being of patients with headache: measurement by the medical outcomes study instrument [abstract] Headache. 1993;33(7):351–358. - PubMed
    1. The International Classification of Headache Disorders. Cephalalgia. 2013;33(9):629–808. 3rd ed (beta version) - PubMed

Publication types