title: The assessment of headaches on the acute medical unit: is it adequate and how could it be improved? .
abstract: Neurological emergencies represent 15-25% of the medical take, second only to cardiac and respiratory cases. However, the UK's number of neurologists is lower than that of other developed nations. This quality improvement project aimed to develop a guideline to optimise acute headache management by non-specialists, informed by the findings of a survey and audit of doctors' knowledge and practice. In total, 62 doctors responded to our survey. 53/56 (94.6%) agreed a guideline would be useful. Knowledge of some important causes of headache was high, but was lower for others, including cerebral venous sinus thrombosis and cervical artery dissection. A consultant neurologist deemed 14/27 (51.9%) of acute headache presentations audited pre-guidelines to have had appropriate management. After guideline launch, a re-audit demonstrated this proportion was 18/22 (81.8%) (p=0.04). We conclude the investigation and management of acute headache requires optimisation and a guideline may help to achieve this.
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, UK sophiebinks@doctors.org.uk.
authors.forename: Sophie
authors.initials: S
authors.lastname: Binks
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Nagy
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Jeban
authors.initials: J
authors.lastname: Ganesalingam
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Abarna
authors.initials: A
authors.lastname: Ratnarajah
mesh_terms: D000208:Acute Disease; D004632:Emergency Medical Services; D006261:Headache / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D009422:Nervous System Diseases / Q000175:diagnosis; D010820:Physicians / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D013129:Spinal Puncture; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Acute medicine; guideline; headache; lumbar puncture; thunderclap