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

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

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

A scoping review of the published literature following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) guidelines, and a narrative review of the evidence.

An electronic search of MEDLINE and Embase (1974-2024) was undertaken. Studies meeting the eligibility criteria were included. Results were grouped by study type and were reported narratively.

In total, 1125 articles were screened, 43 articles underwent full-text review, and 28 articles were included in the final review. Six studies used comparative methods, of which n = 3/6 investigated educational interventions. The educational interventions found positive effects on learning, and on outcomes such as diagnosis rates, but the only randomised controlled trial (RCT) did not show any benefits of the intervention. Other comparative studies showed satisfaction with GP with an extended role (GPwER) headache services, benefits from direct access to magnetic resonance imaging (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, GPwER, and nurse-led interventions.

Despite the availability of high quality clinical guidelines on the assessment and management of headache, the evidence shows that its 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, refine, and deploy interventions that have a signal of efficacy.