Headaches are one of the most common neurological problems presented to GPs and neurologists, affecting over 90% of the population at some point in their lifetime.

Download this poster to read more about our work around the headache pathway.

  • Over 4% of adults consult their GP with headache each year
  • Headache is mainly managed within Primary Care but accounts for up to 25% of GPs referrals to neurologists
  • GPs and Neurology consultation rates due to chronic headache have steadily increased over the past years.

GPs are also able to refer patients directly for Magnetic Resonance Imaging (MRI), but at present, there is a mixed uptake of this service.

Aim of TOHETI Headache study was to evaluate whether direct access from GPs to Magnetic Resonance Imaging (MRI) for patients with chronic headache is cost-saving at 6 months after the initial episode at Secondary Care, compared to an initial referral from GPs to Neurology. Please note that the study is not currently recruiting. We completed recruitment in Feb’2018 ( 249 patients recruited in the study). Our current focus is on follow up on recruited patients and compiling their data.

In the vast majority of cases where patients are directly referred to MRI, no serious underlying pathology will be found, enabling earlier GP and patient reassurance. For the few patients with worrying pathology, this will speed up the diagnostic pathway to tertiary care.

Proposed benefits

  • Earlier patient reassurance where no serious underlying pathology is found.
  • Faster diagnosis and treatment in patients with brain tumours
  • Supports patient management within the primary care setting due to reassurance effect
  • Reduced number of referrals to Neurology as a result of direct access to MRI exams
  • Release of Neurology capacity to improve the response to other neurologic conditions
  • Higher GP and patient satisfaction under the MRI pathway

A qualitative study is taking place now to focus on GP’s views on direct access to MRI scanning for patients with chronic headache, versus referral to neurology.

  • “We are comparing two pathways for patients with chronic headache to assess cost-effectiveness, patient satisfaction and outcome. One involves enabling direct GP access to imaging and the other is via referral to Neurology. The outcome of the study will enable us to improve and develop future headache pathways.” Dr Shazia Afridi, Consultant Neurologist, Guy’s and St Thomas’ NHS Foundation Trust; Chief Investigator TOHETI Chronic Headache Research Pathway (Quantitative)

  • “Headaches are rarely serious, and most scan results are normal. A normal result may help reassure patients anxious about a serious underlying cause for their headaches, and facilitate shared decision making for migraine management. GPs that make use of direct access can help reduce neurology waiting lists and improve patients’ experience of the pathway to better headache care.” Dr Leone Ridsdale, Professor of Neurology and General Practice, King’s College Hospital; Chief Investigator TOHETI Chronic Headache Research Pathway (Qualitative)

MRI brain