Evaluation of referrals to the migraine clinic at Mater Dei hospital : a clinical audit

Abstract

BACKGROUND: The recently established migraine clinic at Mater Dei hospital in Malta has been receiving a steady stream of referrals from a number of sources for the investigation and management of patients with suspected migraine headaches. This necessitated the need for a retrospective analysis and clinical audit to determine the appropriateness of referrals to the migraine clinic.

METHODS: Data was collected retrospectively from tickets of referral and migraine clinic notes from patients’ medical records over an 18 month period.

RESULTS: A total of 63 new case referrals were received with an appointment being given within an average of 18 weeks from the date of referral; 74.6% were female and 25.4% were male with a mean age of 35 years. Six discrete sources of referral were identified including General Practitioners (GP) 25.4%, Accident and Emergency (A&E) 15.9%, inpatients 11.1%, ophthalmology emergency 9.5%, ENT emergency 3.2% and outpatients 3.2%; Attendance rates to the first appointment were 65.1%; 55.1% of patients received a diagnosis of primary headache, of which migraine with aura was the most common (63.0%); 49% of attending patients were referred appropriately with 37.5% of these being referred by GPs and 29.2% being referred from the emergency services.

DISCUSSION: Just under half of referrals to the new migraine clinic are appropriate, necessitating the need to improve the quality and accuracy of referrals by defining a clear pathway for referral as well as improving the management at the primary care level by educating both providers and patients in the way of diagnosing and managing headache disorders.