• Alina Buture, Fayyaz Ahmed, Yachna Mehta, Koen Paemeleire, Peter J Goadsby, and Lisa Dikomitis.
• Hull York Medical School, University of York, York, UK; neurology registrar, Neurology Department, Beaumont Hospital, Dublin, Republic of Ireland.
• Br J Gen Pract. 2020 Jul 1; 70 (696): e514-e522.

BackgroundCluster headache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain, ipsilateral cranial autonomic features, and a tendency to circadian and circannual periodicity.AimTo explore the perceptions, experiences, and understandings of cluster headache among GPs and neurologists.Design And SettingQualitative interview study in primary care surgeries and neurology departments in the north of England.MethodSemi-structured interviews were conducted with GPs and neurologists, recorded, and transcribed. A thematic analysis was applied to the dataset.ResultsSixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the cluster headache diagnosis; impact of cluster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians recognised the delays in the diagnosis of cluster headache, misdiagnosis, and mismanagement, and were aware of the potential impact cluster headache can have on patients' mental health and ability to remain in employment. Findings highlighted tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens. Patients' anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals.ConclusionClinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of cluster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs.© British Journal of General Practice 2020.

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