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Primary care management of headaches and how direct-access MRI fits: a qualitative study of UK general practitioners’ views
  1. Raphael Underwood1,
  2. Rachael Kilner2,
  3. Leone Ridsdale1
  1. 1Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  2. 2South Lambeth Road Practice, London, UK
  1. Correspondence to Dr Raphael Underwood; raphael.underwood{at}


Objectives To develop a better understanding of general practitioners’ (GPs) views and experiences of the management of patients with headaches and use of direct-access MRI scans, and observe outcomes of an educational session offered by a GP with a special interest (GPwSI) to GPs.

Design A qualitative study using semistructured interviews, analysed using thematic analysis. A GPwSI in headaches visited practices delivering a talk on headache medication, diagnosis and management.

Setting Sixteen (16) primary care family practices in South London, UK.

Participants Twenty (20) GPs.

Results Not all GPs were aware of the availability of direct-access MRI, but all acknowledged having used referral or direct scans to manage patients’ concern about their headaches. A normal scan result helped resolve uncertainty for patient and GP and helped management towards discussion of preventative treatment. However, patients with psychological and/or severe headache symptoms could not necessarily be reassured. GPs reported difficulty interpreting radiology reports, particularly incidental abnormalities. Those who received the educational talk gained knowledge in diagnosis and medication, improving their confidence in management.

Conclusions Increased access to imaging, training in headache management, addressing physical and psychological symptoms and standardised reporting of scans may improve GPs’ use of direct-access MRI in the future.

  • headache
  • general practice
  • magnetic resonance imaging
  • qualitative research
  • neurology
  • mental health

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  • Contributors RU: design, data collection, analysis, interpretation, write-up, editing, final approval and agreement to be accountable for integrity/accuracy of content. RK: design, data collection, interpretation, revising of content, final approval and agreement to be accountable for integrity/accuracy of content. LR: design, analysis, interpretation, revising of content, final approval and agreement to be accountable for integrity/accuracy of content.

  • Funding This work was supported by the Guy’s and St Thomas’ Charity but not through a specific grant. This project is part of the Transforming Outcomes and Health Economics through Imaging (TOHETI) programme.

  • Disclaimer The views expressed are those of the authors and not necessarily those of our funders or collaborators.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from the Psychiatry, Nursing & Midwifery Research Ethics Subcommittee at King’s College London (LRS-14/15-0662) and written consent obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data can be accessed via the Dryad data repository at with the doi:10.5061/dryad.p6n8f.

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