Referral and distribution of ophthalmic causes of headache among patients presenting to a tertiary hospital

Dear Editor, In a study performed on adult patients presenting with headache as the primary symptom to the screening outpatient department (OPD) of a tertiary hospital in Central India, the existing pattern of referral to various specialty OPDs was studied. In the first of two phases, 4% (n = 98) of 2289 new patients presented primarily with headache, 17% of whom were referred to the Ophthalmology department and 61% to the General Medicine department by the screening nurse [Table 1]. Some patients were referred to Ophthalmology secondarily by other departments. A total of 16% among this entire subset of patients received a plausible Ophthalmic diagnosis for headache.Table 1: Referral pattern from the screening counter: Phase 1In the second phase, all new patients presenting to the screening OPD with headache, that is, 3% (n = 78) of 2449, were first referred to the Ophthalmology department; onward referrals were made to other departments if required. A jump of 175%, from 16% (phase 1) to 28% (phase 2), was noted among those from the screening OPD subgroup who received an Ophthalmic diagnosis for headache [Charts 1 and 2], with refractive error being the most common in both phases. It is prudent to infer that most of these diagnoses might have been missed if preexisting referral patterns had been followed.Chart 1: Phase-wise distribution of Ophthalmic causes of HeadacheChart 2: Composite methodology and result flowchartAmong the subgroup of self-registered patients with headache, however, 68% and 39%, respectively, were detected to have ophthalmic causes in the two phases. While patient awareness initiatives are likely to help this subset, it is emphasized that for the chunk of patients presenting with headache, strong referral-based protocols need to be developed to and from ophthalmology. It may further be reasoned to make it imperative for all patients presenting with headache to have an eye examination for Ophthalmic causes. With varied etiologies and complex multifactorial classifications for headache,[1] setting up multispecialty headache centers with due representation of Ophthalmic sciences in headache fora and fellowships is warranted. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.