Headache management in general practice

Reading David PB Watson1 and David Kernick,2 we are really impressed by the strong similarities between the UK and Italian situation in this field.

As a neurologist working in a headache centre (out-patients service) in Milan, and a GP with teaching roles, we agree of course with all the theoretical statements by Watson (90% primary headache, no need for imaging in most cases, etcetera), and also with the complaint about limited GPs' interest and participation in headache patients' care and follow-up.

We have just one remark to add: for a correct diagnosis, a careful history is very important, but what is also useful is a neurological examination (and maybe a fundus of the eye examination). Both could be performed by a skilled GP, and only in some cases may require a specialist consultation.

Also for follow-up, GPs, being closer to their patients than specialists, could obtain easier careful registration for the course of headache attacks, and could prevent medication abuse.

• © British Journal of General Practice, 2008.