1. GP headache consulters & referred 4% of adults pa consult GPs for headache 97% managed by GPs, 2% referred to neurologists Latinovic et al: JNNP 2005 25% of referrals to neurologists for headache Ridsdale et al: ABN 2005/11 MRC Cohort study High impact, disability, and emotional distress No difference in these clinical characteristics between GP consulters and those referred Ridsdale et al: BJGP 2007

2. Headache impact, satisfaction & cost in hospital & in GPwSI clinics Headache impact no different in those referred to hospital & GPwSI clinics Patient satisfaction with clinics Hospital 72% of maximum, GPwSI 79% (p=0.002) waiting time, access, being listened to & understood, help they had received, extent to which their needs were met, relieving their symptoms, ability to deal more effectively with their problems, overall more agreed:- it is the kind of service they wanted. CostsGPwSI service less costly £150 vs £200 pp Ridsdale et al BJGP 2008

3. GP headache consulters & referred are different GP consulters for headache n = 255 Referred to neurologist n = 48 p-value Headache-related symptoms mean (sd) 7.1 (4.9)8.8 (5.0)0.011 My headaches do not worry me (reverse scored) median (IQR) 4 (3 to 4)4 (4 to 5)<0.001 My headaches make me feel anxious median (IQR) 3 (2 to 4)4 (3 to 4)0.04 No of consultations with GP for headache in 6 months mean (sd) 0.8 (1.3)1.8 (2.4)<0.001 GPs views- why they refer ultimately they (patients) say that's all very interesting and thank you very much for the time you've taken, but I still want to see someone … everybody feels they need a scan as soon as they've got a headache they feel they need a scan Morgan et al BJGP 2007, Ridsdale et al BJGP 2007