The Medical Protection Society (MPS) has helped refine the NICE Clinical Knowledge Summaries (CKS) advice for headache and subarachnoid haemorrhage (SAH), to enable healthcare professionals to diagnose SAH earlier. 

Subarachnoid haemorrhage – bleeding on the surface of the brain – is a rare but catastrophic cause of headache, the cardinal symptom being an instantaneous onset. MPS’s Learning from Cases Team has helped to refine the Headache Summary by adding that a headache caused by subarachnoid haemorrhage is not always severe. This is important because almost all screening questions for SAH are based on the headache being ‘sudden and severe’.

The additional advice, supported by consultant neurosurgeon, Mr Francis Johnston, states:

Expert neurosurgical opinion on the presentation of subarachnoid haemorrhage advises that the headache is not always severe but is usually, but not always, accompanied by nausea and vomiting.

MPS Medical Claims Adviser, Dr Philip White, recommended the change after recognising that the headache not being severe is one of the reasons why the diagnosis is sometimes missed. 

He said: “Headaches that present like a ‘thunderclap’ can be characteristic of several serious underlying pathologies, including subarachnoid haemorrhage. However, the headache associated with subarachnoid haemorrhage will not always be severe. This is not a new discovery, but it probably is the first time for it to appear in guidelines for generalists.

“In cases where a sub-arachnoid haemorrhage is not diagnosed promptly it can lead to the patient requiring long-term care and high value clinical negligence claims”.

“MPS has extensive experience and expertise which it uses to make clinical practice safer and reduce risk for members. As a leading medical defence organisation, we are in a unique position to see why diagnoses are missed, help to prevent it happening again, and ultimately improve patient outcomes.

“Using this information to help members and patients by working with national guidelines developers is very satisfying and at the heart of what we do at MPS.”

Dr Gerry Morrow, Medical Director at Clarity Informatics, who oversees the CKS on subarachnoid haemorrhage, said: “We know that primary care clinicians rely on the Clinical Knowledge Summaries as a source of trusted information. We are always looking for expert advice on improving our recommendations. It has been an extremely valuable process working with MPS and their experts on this topic. We are delighted with the improved subarachnoid headache information, which has resulted from this collaboration.”

Mr Francis Johnston, a Consultant Neurosurgeon who supported the changes, added: “In suspected cases of subarachnoid haemorrhage, there is no room for error due to the gravity of the diagnosis. If there remains any clinical doubt, diagnostic advice should be sought from the local neurosurgical unit.”

ENDS

Editors Notes

The NICE Clinical Knowledge Summaries (CKS) service provides primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice in respect of over 370 common and/or significant primary care presentations.

Healthcare professionals can view the full updated guidance at: https://cks.nice.org.uk/headache-assessment#!scenario 

For more information, please contact Mike Bridge at E: [email protected] or T:+44 (0)207 640 5167, M:+44 (0)7773 573303.

About MPS:

The Medical Protection Society (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support together with the right to request indemnity for complaints or claims arising from professional practice.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.