Headache and migraine in primary care: consultation, prescription, and referral rates in a large population.
OBJECTIVE
Headache is the most common new neurological symptom seen by general practitioners and neurologists. This study describes headache consultation, prescription, and referral rates in a large sample of UK general practices.


METHODS
Analysis of data from patients > or = 15 years registered at 253 UK general practices diagnosed with headache/migraine from 1992 to 2000. Rates were age standardised using the European standard population for reference.


RESULTS
There were 13.2 million patient years of observation. Headache consultation rates were 6.4/100 patients/year in women and 2.5 in men. They were highest at 15-24 years (15.8/100 in women; 5.8/100 in men), decreasing with age. Antimigraine drugs were prescribed at 36.7% of consultations for women and 26.6% for men. Among referrals to specialists, 55% were to neurology and 30% to general medicine. The neurology referral rate in patients with headache was 2.1/100, and was higher in men (2.7/100) than women (1.9/100).


CONCLUSIONS
These results provide precise age specific and age standardised estimates for headache consulting in general practice, in addition to prescribing and referral to specialist care. Consultation rates are highest in young women; hospital referrals peak in middle aged men. Research is needed into reasons for referral, and on better ways of delivering headache services.
Division of Health and Social Care Research, King's College London, 5 Lambeth Walk, London SE11 6SP, UK.
R
R
Latinovic
M
M
Gulliford
L
L
Ridsdale
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D020773:Headache Disorders / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000453:epidemiology*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013038:Specialization; D006113:United Kingdom; D014600:Utilization Review / Q000706:statistics & numerical data
D000700:Analgesics