title: Experience from two decades of the Cambridge Rapid Access Neurology Clinic.
abstract: We report on the evolution of the rapid access neurology clinic (established in 1995) at Addenbrooke's Hospital, Cambridge. Annualised attendance data demonstrate an ever increasing demand, with primary headache disorders now accounting for more than 40% of referrals. Secondary causes of headache (including intracranial tumours, idiopathic intracranial hypertension, carotid or vertebral artery dissection and subdural haematomas) remain infrequent. In all such cases, there were additional diagnostic clues. The number of patients referred with problems related to chronic neurological diseases has fallen considerably, reflecting the roles of specialist nurses and clinics. Imaging investigation of choice shifted from computerised tomography scan (45 to 16%) towards magnetic resonance imaging (17 to 47%). Management is increasingly on an outpatient basis, often without the need for a follow-up appointment. The experience presented here should inform further development of rapid access neurology clinics across the UK and suggests the need for acute headache services, in line with those for transient ischaemic attack and first seizure.
authors.affiliation: Barnet General Hospital, London, UK.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Axinte
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: Barnaby D
authors.initials: BD
authors.lastname: Fiddes
authors.affiliation: Royal Victoria Hospital, Belfast, UK.
authors.forename: Alastair
authors.initials: A
authors.lastname: Donaghy
authors.affiliation: John Radcliffe Hospital, Oxford, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Whyte
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Allen
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sawcer
authors.affiliation: Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adam
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: Sybil R L
authors.initials: SR
authors.lastname: Stacpoole
mesh_terms: D000553:Ambulatory Care; D006261:Headache / Q000209:etiology; D006801:Humans; D009422:Nervous System Diseases / Q000628:therapy; D010044:Outpatient Clinics, Hospital / Q000639:trends*; D006113:United Kingdom
keywords: Acute neurology; headaches; rapid access