Title : FHTH: Find the Headache, Treat the Headache – diagnosis and management of headache in acute, a re-audit
Abstract:
Headaches are a prevalent neurological condition that significantly impacts patient quality of life and healthcare resources. A concerning trend of frequent readmissions for headaches prompted the Urgent Care multidisciplinary team to analyze current diagnosis and management practices. An audit was conducted to address key issues, including failure to meet international diagnostic criteria, inappropriate pain management at discharge, unclear follow-up plans, and inefficient headache pathways. Additionally, the audit examined opioid prescribing patterns to track progress or identify relapses in previous trends. Despite a defined headache pathway endorsed by the Integrated Care Board and collaboration between primary and secondary care, inefficiencies persist, particularly in the Eastbourne area. Many patients are discharged in pain or without clear follow-up plans, resulting in high readmission rates and extended waiting times for outpatient neurology appointments, which average six to nine months. The audit sought to identify gaps in adherence to the International Classification of Headache Disorders (ICH-3) and examine the accuracy of diagnoses for primary and secondary headaches. It also reviewed the documentation of over-the-counter (OTC) medication use, patient counseling on headache diaries and trigger avoidance, acute treatment appropriateness, and consideration of prophylaxis. Readmissions and follow-up plans were analyzed, focusing on whether patients were referred to GPs or neurologists appropriately.
Data were collected retrospectively from discharge letters, patient notes, and admission records for 100 randomly selected patients presenting with headaches at the Eastbourne Emergency Department and Same Day Emergency Care unit between June and December 2023. Of these, 84 patients were included in the analysis. Results revealed significant shortcomings: only 18 patients had diagnoses meeting ICH-3 criteria, and OTC medication histories were documented for just 1.2% of cases. No patients were counseled on headache diaries or trigger avoidance. Acute treatment was appropriate for only 22 patients, and prophylaxis was not initiated for any patients. Ten patients received opioids during admission, contrary to guidelines, and 21 were readmitted, mostly for primary headaches. Follow-up planning was inadequate, with 72% of neurology referrals deemed inappropriate and suitable for GP management instead.
The findings emphasize the need for enhanced training to improve diagnostic accuracy, particularly for primary headaches, and better adherence to guidelines. Improvements were noted in acute treatment and reduced opioid prescribing compared to previous audits. However, significant challenges remain, including underutilization of triptans for migraines and insufficient patient education about medication overuse. Recommendations include implementing training programs to enhance diagnostic accuracy, developing patient information leaflets to streamline counseling, and establishing clearer criteria for neurology referrals. These measures aim to improve patient outcomes, reduce readmissions, and optimize healthcare resource use. The audit underscores the importance of addressing these gaps to improve headache management in the Eastbourne area. By ensuring accurate diagnoses, appropriate treatment, and better follow-up plans, healthcare teams can reduce the burden of headaches on patients and the healthcare system, ultimately enhancing care quality and efficiency.
