title: Primary care direct access MRI for the investigation of chronic headache.
abstract: OBJECTIVE
  To assess the efficacy of a primary-care imaging pathway for neurology outpatients, from inception to deployment, compared with traditional outpatient referral.
  
  
  METHODS
  After local agreement, guidelines were generated providing pathways for diagnosis and treatment of common causes of headache, highlighting "red-flag" features requiring urgent neurology referral, and selecting patients for direct magnetic resonance imaging (MRI) referral. In addition, reports were clarified and standardized. To evaluate the efficacy of the access pathway, a retrospective sequential review of 100 MRI investigations was performed comparing general practitioner (GP) referral, with traditional neurology referral plus imaging, acquired before the pathway started.
  
  
  RESULTS
  No statistically significant difference in rates of major abnormalities, incidental findings or ischaemic lesions were identified between the two cohorts. Reported patient satisfaction was high, with a cost reduction for groups using the pathway.
  
  
  CONCLUSIONS
  The findings of the present study suggest that a defined access pathway for imaging to investigate chronic headache can be deployed appropriately in a primary-care setting.
authors.affiliation: Queens Medical Centre, Nottingham, UK. timt@nhs.net
authors.forename: T R
authors.initials: TR
authors.lastname: Taylor
authors.forename: N
authors.initials: N
authors.lastname: Evangelou
authors.forename: H
authors.initials: H
authors.lastname: Porter
authors.forename: R
authors.initials: R
authors.lastname: Lenthall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D055815:Young Adult