By Christian Duffin
Headache in adult patients should be investigated by giving GPs direct access to CT scanning, says a top expert at NICE.
Dr David Kernick, a GP in Exeter and a NICE fellow, makes this argument as a co-author in a paper in the British Journal of General Practice, but he stressed that patients with headaches presenting with neurological signs would require urgent neurological referral.
He said referring patients with headaches to MRI would not be appropriate because of the greater costs involved and the increased number of incidental findings 'that may cause anxiety'.
Dr Kernick said: 'When patients present with headache, the evidence base to support a decision on who to investigate and how to do so is limited and of poor quality. It may be that the development of a headache service for GPs with a special interest would reduce investigations and provide a more cost effective service overall, but there is currently no rigorous evidence to support other care pathways.'
He added: 'Until rigorous studies comparing the cost utility and cost benefit of CT/MRI are available, the existing evidence suggests that GPs can refer for investigation appropriately and reduce secondary care referrals. We suggest that GPs have direct access to CT, unless patients with headache present with associated neurological signs and urgent neurological referral is indicated.'