A headache pathway and referral form was implemented across Southwest London in September 2020 – it includes prompts about migraine preventer use. This study aimed to assess its use at Croydon University Hospital.

From 07/04/2021 to 05/08/2021, data were extracted retrospectively from referral and clinic letters for neurology outpatients (first appointments only) given a diagnostic code of a primary headache disorder; including the number of ED attendances in the year before and 3-6 months after their appointment. Appropriateness was determined against the recommendations in the pathway.

Primary headaches accounted for 153 (8%) first appointments compared to 13% in 2016. 73% were dis- charged. 26% of referrals used the referral form with 37% being appropriate. The main reasons for referral were seeking advice (35%) and uncertain diagnosis (33%). 42 had at least 1 Croydon ED attendance in the year before their appointment reducing to 6 in the 3-6 months afterward.

Despite this pathway coming into use during the pandemic, a quarter of referrals exercised the form. As it embeds and with the use of Advice and Guidance and teaching, we hope to enable more GPs to be confident in managing these patients.