Primary care management of headaches and how direct-access MRI fits: a qualitative study of UK general practitioners’ views

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.