title: Diagnosing headache in primary care: a qualitative study of GPs' approaches.
abstract: BACKGROUND
  Headache is one of the most common symptoms in primary care. Most headaches are due to primary headaches and many headache sufferers do not receive a specific diagnosis. There is still a gap in research on how GPs diagnose and treat patients with headache.
  
  
  OBJECTIVE
  To identify GPs' diagnostic approaches in patients presenting with headache.
  
  
  METHODS
  Qualitative study with 15 GPs in urban and rural practices.
  
  
  METHODS
  Interviews (20-40 minutes) were conducted using a semi-structured interview guideline. GPs described their individual diagnostic strategies by means of patients presenting with headache that they had prospectively identified during the previous 4 weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.
  
  
  RESULTS
  Regarding GPs' general diagnostic approach to patients with headache, four broad themes emerged during the interviews: 'knowing the patient and their background', 'first impression during consultation', 'intuition and personal experience' and 'application of the test of time'. Four further themes were identified regarding the management of diagnostic uncertainty: 'identification of red flags', 'use of the familiarity heuristic', 'therapeutic trial', and 'triggers for patient referral'.
  
  
  CONCLUSIONS
  GPs apply different strategies in the early diagnostic phase when managing patients with headache. Identification of potential adverse outcomes accompanied by other strategies for handling uncertainty seem to be more important than an exact diagnosis. Established guidelines do not play a role in the diagnostic workup.
authors.affiliation: Department of Family Medicine, University of Marburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bösner
authors.affiliation: Department of Family Medicine, University of Marburg, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Hartel
authors.affiliation: Department of Family Medicine, University of Marburg, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Diederich
authors.affiliation: Department of Family Medicine, University of Marburg, Germany.
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
mesh_terms: D042241:Early Diagnosis; D005260:Female; D058005:General Practitioners; D005858:Germany / Q000453:epidemiology; D006261:Headache / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011446:Prospective Studies; D036301:Qualitative Research; D012017:Referral and Consultation
keywords: diagnosis; general practice; headache; qualitative research