Perceptions, experiences, and understandings of cluster headache among GPs and neurologists : a qualitative study

Background: Cluster hoatiache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain. ipsilateral cranial autonomic features, and a tendency to arcadian and arcannual penodicity. Aim: To explore the perceptions, experiences, and understandings of duster headache among GPs and neurologists. Design and setting: Qualitative interview study in primary care surgeries and neurology departments in the north of England. Method: Semi-structured interviews were conducted with GPs and neumlogists, recorded, and transcribed. A thematic analysis was applied to the dataset. Results: Sixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the duster headache diagnosis; impact of duster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians rersignised the delays in the diagnosis of cluster headache, misdiagnosis. and mismanagement, and were aware of the potential impact duster headache can have on patients mental health and ability to remain in employment. Findings highlighted tensions between pnmary and secondary care around the cost of medication and the remit of prescnbing treatment regimens. Patients anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals. Conclusion: Clinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of duster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs