Bridging the gap in headache care: a qualitative needs assessment for primary care education in Indonesia

Headache is a common complaint encountered in primary care. In Indonesia, however, only migraine and tension-type headache are expected to be fully managed by general practitioners (GPs). Effective management requires a comprehensive understanding of headache diagnosis, treatment, and appropriate referral in primary care settings. Educational interventions for GPs are therefore essential to address existing unmet needs. This study aims to conduct a needs assessment to identify barriers in headache management in primary care and to determine gaps that can inform the development of targeted interventions. We conducted in-depth interviews with headache stakeholders and focus group discussions involving practitioners from government-owned and privately-owned primary care facilities. Verbatim was analyzed and categorized into themes. The themes from in-depth interviews and focused group discussions are compared and synthesized to make recommendations for the module development. Several critical gaps were identified. First, history taking was acknowledged as essential but was often constrained by time-limited consultations and lack of structured diagnostic tools. Second, while practitioners recognized the importance of headache red flags, their application in clinical decision-making was inconsistent, leading to uncertainty in referral thresholds. Third, knowledge of secondary headache disorders and medication-overuse headache (MOH) was limited; MOH was frequently unrecognized as a distinct clinical entity. Fourth, the use of international headache guidelines and standardized diagnostic criteria was minimal, mainly due to perceived complexity and limited relevance to local practice. Based on these findings, stakeholders and practitioners agreed that priority module components should include: (1) a focused history-taking guide, with approach based on red flags for secondary headache, (2) simplified diagnostic algorithms (3) focused section on MOH and management, and (4) guidance on treatment choices aligned with locally available medications. Interactive, case-based workshops, delivered offline or in hybrid formats, were preferred. This study provides evidence regarding barriers in headache diagnosis, treatment and referral in Indonesian primary care and translates them into concrete educational priorities. A GP headache learning module should emphasize practical diagnostic strategies, early identification of secondary headache and MOH, and guideline implementation adapted to local resource constraints and consultation realities. Our findings offer a structured framework for developing focused continuing medical education to strengthen headache management in Indonesia.