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Q&A Dr David Kernick, GP with special interest in headache
How did you become a GP with a special interest in headache? I drifted into an interest in headache on the back of a research grant. I have to admit that at the time headache was rather “heart sink” to me. The PCT had some money left over at the end of the fi nancial year, I helped one or two of their executives who had a problem with migraine and things seem to evolve from there. These days service development is far more planned!
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As part of a vocational training programme As a clinical placement agreed locally As part of a recognised university course
Successfully completing a postgraduate course in headache management
Evidence of working under direct supervision with a specialist clinician in relevant clinical areas.
BASH has also published frameworks for appraisal and training,
accreditation and re-accreditation together with management pathways that can be adapted for local circumstances. These can be found on
www.exeterheadacheclinic.org.uk together with other material to support the commissioning of headache services. A young GP who would like to develop skills towards becoming a GPwSI in headache is advised to contact a local headache clinic (see the BASH website below for a locator map) and ask about training opportunities and the possibility of sitting in on a clinic. You can also join BASH.
Dr David Kernick is a GP with a special interest in headache at the Exeter Headache Clinic at the St Thomas Health Centre
Some useful sites •
www.bash.org.uk British Association for the Study of Headache guidelines. BASH has a GPwSI group. (Contact
david.kernick@
nhs.net)
•
www.exeterheadacheclinic.org.uk Contains support for commissioners, patient information and advice sheets which can be downloaded.
Patient organisations •
www.migrainetrust.org Migraine Trust
•
www.migraine.org.uk Migraine Action Association
What opportunities are there for the development of GPwSI headache services? Invariably headache contains biopsychosocial elements and the GP is well placed to manage this condition. In general, neurologists are not interested in headache and patients referred to secondary care can receive inappropri- ate investigation and their needs are often not met. Headache is the most common neurological presentation and commissioners will be looking at ways to reduce these referrals. GPs with a special interest can off er better services at reduced costs and also provide educational input for their colleagues who often fi nd headache diffi cult to manage.
What do you most enjoy about the role? Although most of what we see is migraine, every case is very diff erent. In many cases you can turn around the lives of people when their problem is having a signifi cant impact upon them and their families. Having 45 minutes to spend with a patient is a real luxury and it makes you realise how much more we could sort out with our own patient’s problems if we had more than the pressurised 10 minutes.
What do you fi nd most challenging about the job? Overlooking a serious secondary pathol- ogy is always a cause for concern. Sooner or later a coincidental brain tumour will present. All one can do is to follow established guidelines and have a documented conversation with the patient about the pros and cons of imaging. Our imaging rates are very low and in most cases a scan is unnecessary.
Do you need a background in neurology to develop an interest in this area? Although a basic knowledge of neurology is important, particularly for excluding secondary pathologies, this is no more than a competent GP would be expected to know. In 95 per cent of headache presentations, the underly- ing pathophysiology is not known and the focus is on clinical pattern recognition and not the nuances of neuroanatomy. Clinical experience is probably the most important attribute.
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