Evaluating headache referral trends and practices across different settings in neurology clinics: insights from an international cross-sectional multicenter study

Background: Misdiagnoses often lead to suboptimal therapeutic approaches, making early and accurate diagnoses by experts crucial for effective headache management. This study primarily aims to investigate the referred patient profiles with headaches to optimize diagnostic and referral approaches. Methods: In this cross-sectional multicenter international study, sixty-nine neurologists from 13 countries evaluated headache patients referred to neurology clinics (NCs). Researchers recruited patients on different weekdays selected by the research randomizer program for five consecutive weeks in April and May 2022. The clinicians collected data on various factors such as age, sex, headache characteristics and accompanying symptoms using the Head-MENAA study questionnaire and the International Classification of Headache Disorders-3 (ICHD-3) criteria. Patients were grouped according to the settings as emergency services (ESs), other specialty clinics (OSCs) and private offices (POs) in which they were evaluated. Results: A total of 3722 individuals out of 12043 evaluated in NCs had headache complaints. Among them, 15.07% consisted of patients referred to neurology by these three different settings. 14.8% of them were referred from ESs, 16.58% from OSCs, and 68.64% were applied to POs. While there was not a significant difference between groups regarding the mean age, the proportion of male patients in the ESs (49.4%) was higher than those in OSCs (26.9%) and POs (23.1%) (p < 0.001). Headache severity was higher in the ESs and POs than in the OSCs and Neurology Outpatient Clinics (NOCs) (p < 0.001). Primary headaches were the reason for consultation in 89.2% of patients in the ESs, 90.3% of patients in OSCs and 93.5% of patients in POs, migraine without aura being the most common headache type in all groups. Conclusions: This study suggests that preferences for admission and referral may vary based on demographic characteristics, types and severity of the headache, as well as accessibility and availability of different settings.

Referred patients; Headache severity; Headache frequency; Lifetime pain duration; Primary headaches; Secondary headaches; Neurology clinic; Emergency service; Specialty clinic; Private office

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