Bridging the Gap in Headache Care : A Qualitative Needs Assessment for Primary Care Education in Indonesia

Introduction: Headache is frequently encountered in primary care. However, in Indonesia, only migraine and tension-type headache are expected to be fully managed by general practitioners (GPs). To do so, a comprehensive understanding of headache diagnosis, treatment, and referral in primary care is needed. We aim to do a needs assessment of the barriers in headache management in primary care to identify gaps in formulating interventions. Methods 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. Results Stakeholders, including practitioners, emphasized the importance of recognizing headache red flags that may indicate secondary headache is an important aspect in headache diagnosis, and that history taking should be a crucial part of the headache assessment. In addition, the concept of MOH is unfamiliar, and secondary headaches are partially understood by practitioners. Use of guidelines and diagnostic standards is also limited. Both agree that MOH should be taught to GPs in interactive workshops with case simulations, in an offline or combined online format. Conclusion Recognizing emergencies, using standardized diagnostics, and implementing guidelines should be incorporated in a headache learning module for GPs. Module content should adapt to local settings, with respect to the availability of drugs and the limited duration of patient encounters.