Ability of a nurse specialist to diagnose simple headache disorders compared with consultant neurologists.
OBJECTIVE
To compare the ability of a headache nurse specialist and consultant neurologists in diagnosing tension-type headache and migraine.


METHODS
An experienced neurology ward sister was trained in the differential diagnosis of headache disorders. Over six months, patients with non-acute headache disorders and role players trained to present with benign or sinister headaches were seen by both the nurse and a consultant neurologist. Both reached independent diagnoses of various headache disorders.


RESULTS
Consultants diagnosed 239 patients with tension-type headache (47%), migraine (39%), or other headache disorders (14%). The nurse agreed with the consultant in 92% of cases of tension-type headache, 91% of migraine, and 61% of other diagnoses. Where the nurse did not agree with the diagnosis, most would have been referred for a consultant opinion. Both the nurse and the doctors misdiagnosed the same three of 13 role players. The investigation rate of the consultants varied between 18% and 59%. Only one clinically relevant abnormality was found on head scans and this was strongly suspected clinically.


CONCLUSIONS
A headache nurse specialist can be trained to diagnose tension-type headache and migraine. A nationwide nurse led diagnostic headache service could lead to substantial reduction in neurology waiting times.
Clarke
C E
CE
Academic Department of Neurology, University of Birmingham and Department of Neurology, Sandwell, UK. c.e.clarke@bham.ac.uk
Edwards
J
J
Nicholl
D J
DJ
Sivaguru
A
A
Davies
P
P
Wiskin
C
C
D000328:Adult; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D009462:Neurology; D009720:Nurse Clinicians / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D011361:Professional Competence; D012017:Referral and Consultation