TY - JOUR T1 - Should GPs have direct access to neuroradiological investigation when adults present with headache? JF - British Journal of General Practice JO - Br J Gen Pract SP - 409 LP - 411 DO - 10.3399/bjgp11X578124 VL - 61 IS - 587 AU - David Kernick AU - Stuart Williams Y1 - 2011/06/01 UR - http://bjgp.org/content/61/587/409.abstract N2 - ‘The role of the specialist is to reduce uncertainty, to explore possibility, and to marginalise error. The role of the GP is to accept uncertainly, to explore probability, and to marginalise danger.’1The annual incidence of adult primary brain tumour is 0.01%, of which 72% of patients will present above the age of 50 years.2 Although secondary brain tumours are more common than primary tumours, they are rare as the first manifestation of cancer.3 Although patients with a brain tumour can present with a number of symptoms, headache is invariably a cause for concern for both patient and doctor; however, there is a wide discrepancy in GP access to neuroradiological investigation to exclude this possibility. When a patient presents to their GP with headache, the risk of a brain tumour is 0.09%.4 There is no consistent clinical pattern to the features of headache associated with tumour,5 but the majority will present with additional clinical features. Only 2–16% of primary tumours will present with isolated headache.6–8In the UK, the annual primary care consultation rate for headache is 4.4 per 100 patients.9 Although only 3% of headache consultations are referred to secondary care,9 headache is the most common cause of neurological referral, accounting for over 20% of new cases.10 There is no difference in headache impact between neurology headache referrals and patients managed in primary care, but patients who are referred consult more frequently and have higher levels of headache-related anxiety.11Although there may be benefits from early investigation and diagnosis, these are often marginal; a key factor for referral is patient reassurance12 but, in terms of symptoms … ER -