Simple headache disorders diagnosed by nurse specialist

A well-trained headache nurse specialist can diagnose tension-type headache and migraine with similar accuracy to consultant neurologists, allowing the possibility of headache nurse specialist services.Neurologists in Birmingham say that headache disorders account for around 40% of referrals to their neurology clinic, where there is a shortage of neurologists and long waiting times. Nurse specialists in other fields, such as Parkinson's disease, epilepsy, and multiple sclerosis have been successful in reducing consultant workload, so they considered the feasibility of a nurse-led diagnostic headache service to improve the situation.Over six months, the authors compared the abilities of a consultant neurologist and a neurology ward sister trained in headache disorders in diagnosing tension-type headache and migraine. The nurse and neurologist independently diagnosed various headache disorders in 239 patients and 13 role players trained to present with benign or sinister headaches. The protocol allowed for the nurse to provide an alternative to each primary, secondary and tertiary diagnosis if there was uncertainty. The authors report, "The nurse reached exact agreement with the doctor's primary diagnosis in 68% of tension-type headache participants, 77% of those with migraine, and 34% of other diagnoses." When considering the recorded alternative diagnoses, the nurse agreed with the consultant's primary diagnosis in 92% of tension-type headaches, 91% of migraines and 61% of other diagnoses.There were 30 cases where the nurses and the neurologists' diagnoses were not in agreement, of which 22 had been referred by the nurse for a medical opinion. Most were misclassification of tension-type headache as migraine or vice versa, the authors report. The neurologist and the nurse both misdiagnosed the same three role players, which may have been due to unclear diagnostic details being given in the history.The authors say their hospital's neurology clinic has been modified as a result of the study: "Based on these encouraging results, we have developed a nurse-led headache service in which the nurse is allowed to diagnose tension-type headache and migraine independently and advise general practitioners on treatment according to consultant prepared protocols." Reference...