Prospective evaluation of a nurse-led headache service in a sub-regional neurology unit

A sub-regional neurology unit hired a nurse trained in headache management to diagnose migraine, tension-type headache and medication-overuse headache, as well as advise general practitioners on treatment and collaborate with consultant neurologists in managing other headache disorders. Over 2 years, the nurse saw 1347 new referrals. Most patients had migraine (47%) or tension-type headache (41%) and could be managed by the nurse according to protocols from the British Association for the Study of Headache (BASH). The proportion of patients requiring neuroimaging fell from 29% to 13%. Of those patients with migraine returning for a first follow-up appointment with the nurse, signifi cantly more reported some degree of improvement (n=140, 50.4%) than deterioration (n=43, 15.5%) (P<0.001, binomial test). Similarly, signifi cantly more patients with tension type headache reported some improvement (n=56, 47.5%) compared to deterioration (n=5, 4.2%) (P<0.001). The nurse-led service abolished waiting times exce...