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Ability of a nurse specialist to diagnose simple headache disorders compared with consultant neurologists
  1. C E Clarke1,
  2. J Edwards2,
  3. D J Nicholl1,
  4. A Sivaguru2,
  5. P Davies3,
  6. C Wiskin4
  1. 1Academic Department of Neurology, University of Birmingham and Department of Neurology, Sandwell and West Birmingham Hospitals Trust, City Hospital, Birmingham, UK
  2. 2Department of Neurology, Sandwell and West Birmingham Hospitals Trust, City Hospital, Birmingham
  3. 3Department of Statistics, Institute of Child Health, University of Birmingham
  4. 4Department of Primary Care and General Practice, University of Birmingham
  1. Correspondence to:
 Dr C E Clarke
 Department of Neurology, City Hospital, Dudley Road, Birmingham B18 7QH, UK;


Objective: To compare the ability of a headache nurse specialist and consultant neurologists in diagnosing tension-type headache and migraine.

Methods: An experienced neurology ward sister was trained in the differential diagnosis of headache disorders. Over six months, patients with non-acute headache disorders and role players trained to present with benign or sinister headaches were seen by both the nurse and a consultant neurologist. Both reached independent diagnoses of various headache disorders.

Results: Consultants diagnosed 239 patients with tension-type headache (47%), migraine (39%), or other headache disorders (14%). The nurse agreed with the consultant in 92% of cases of tension-type headache, 91% of migraine, and 61% of other diagnoses. Where the nurse did not agree with the diagnosis, most would have been referred for a consultant opinion. Both the nurse and the doctors misdiagnosed the same three of 13 role players. The investigation rate of the consultants varied between 18% and 59%. Only one clinically relevant abnormality was found on head scans and this was strongly suspected clinically.

Conclusions: A headache nurse specialist can be trained to diagnose tension-type headache and migraine. A nationwide nurse led diagnostic headache service could lead to substantial reduction in neurology waiting times.

  • clinical nurse specialist
  • headache

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  • Competing interests: none declared