Survey questions prior to launch of headache guidelines
| 1. What grade are you? |
| FY1 / FY2 / CMT / GPVTS / speciality grade / registrar / consultant / other |
| 2. In a typical week, how many patients do you see presenting with acute headache? |
| 0 / 1–2 / 3–4 / 5–6 / 7–8 / >9 |
| 3. Which of the following do you routinely examine in patients presenting with acute headache? |
| Neck stiffness / temporal arteries / fundi / thorough cranial nerve exam / upper & lower limb power / upper & lower limb sensation / reflexes / plantars / carotid bruits / mental status, eg AMT or similar / rash / lymphadenopathy |
| Comments: (free text field) |
| 4. What features in the history/examination would prompt you to organise neuro-imaging for a patient with an acute headache? Please list any you would routinely ask about/elicit. |
| 5. On a scale of 0–5, how confident do you feel in RECOGNISING the following presentations of headache? (0 = not aware of condition, 1 = not at all confident, 2 = not confident, 3 = neutral, 4 = quite confident, 5 = very confident). |
| Subarachnoid haemorrhage / haemorrhagic stroke / pituitary apoplexy / posterior reversible encephalopathy syndrome (PRES) / cervical artery dissection / cerebral venous sinus thrombosis / reversible cerebral vasoconstriction (RCVS) / encephalitis / meningitis / acute exacerbation migraine / acute exacerbation cluster headache / carbon monoxide poisoning / acute glaucoma / temporal arteritis |
| 6. On a scale of 0–5, how confident do you feel in the initial MANAGEMENT of the following causes of headache? (0 = no knowledge, 1 = not at all confident 2 = not confident 3 = neutral 4 = quite confident 5 = very confident). |
| Options the same as for question 5. |
| 7. Please indicate your experience in managing these causes of headache. (Never seen a case / seen at least one case or suspected case / seen several cases or suspected cases / managed several cases of this condition). |
| Options the same as for question 5. |
| 8. Would you find a trust acute headache guideline useful? |
| Yes / No / Useful for junior colleagues |
| Comments: (free text field) |
| 9. If you are a senior grade (registrar/consultant), please indicate how you think junior knowledge/clerking of headache compares to the following presentations (not as good / about the same / better / much better). |
| Acute coronary syndromes / acute LVF / acute exacerbation of asthma / acute exacerbation of COPD / pneumonia / sepsis / pulmonary embolism / GI bleed / diabetic ketoacidosis / acute kidney injury / seizure |
| 10. Case vignette: a 30-year-old lady presents with severe headache which reached maximum intensity within seconds. She is usually fit and well with normal BMI, has no relevant family history and her only medication is the oral contraceptive pill. Blood tests (FBC, U&E, LFTs, CRP, ESR, INR) and CT brain is normal and her LP results are as follows: |
| • Opening pressure 27 cm H2O |
| • WCC 3, no organisms seen |
| • Protein 530 mg/L |
| • CSF glucose 4 mmol (paired plasma 6.1 mmol) |
| • No xanthochromia. No evidence to support SAH |
| What is the next appropriate stage in management? |
| Discharge as SAH has been excluded / Keep under investigation for an alternative cause of headache / Discharge with OPD referral to neurology |
AMT = abbreviated mental test; BMI = body mass index; CMT = core medical trainee; COPD = chronic obstructive pulmonary disease; CRP = C-reactive protein; CSF = cerebrospinal fluid; CT = computerised tomography; ESR = erythrocyte sedimentation rate; FBC = full blood count; FY1 = foundation year 1; FY2 = foundation year 2; GI = gastrointestinal; GPVTS = General Practice Vocational Training Scheme; INR = international normalised ratio; LFT = liver function test; LP = lumbar puncture; LVF = left ventricular function; SAH = subarachnoid haemorrhage; U&E = urea and electrolytes; WCC = white cell count