Assessment and treatment of headache in primary care: a scoping review

Background Good quality primary care is essential for the assessment and treatment of headaches but there is evidence that it is suboptimal.

Aim To identify the international evidence on assessment and treatment of headache in adults in primary care.

Design & setting A scoping review of the published literature following PRISMA-SCR guidelines, and a narrative review of the evidence.

Method An electronic search of MEDLINE and EMBASE (1946-2024) was undertaken. Studies meeting the eligibility criteria were included. Results were grouped by study type and were narratively reported.

Results In total 1125 articles were screened, 43 articles underwent full text review, and twenty-eight articles were included in the final review. Six studies used comparative methods, of which 3/6 investigated educational interventions. The educational interventions found positive effects on learning, and on patient outcomes such as diagnosis rates, but the only RCT did not show any benefits. Other comparative studies showed satisfaction with GPwER headache services, benefits from direct access to MRI, and benefits from a nurse-led headache service. Twenty-two studies used non-comparative methods such as surveys and interviews and investigated approaches to assessment/diagnosis, referral rationale, decision-making for prescribing prophylactic medications, educational initiatives, direct access to neuroimaging, GPwSI and nurse-led interventions.

Conclusion Despite the availability of high-quality clinical guidelines on the assessment and management of headache, the evidence shows that their implementation in primary care is problematic and educational interventions are a common focus of published studies. Further research is required to assess the quality of the current evidence and to develop, deploy and refine interventions which have a signal of efficacy.