The New National Headache Management System is an easy solution to provide more efficient and evidence-based headache services

Headaches make up 30% of all Neurology outpatient consultations.1 There is distinct variability in the management of headaches by Neurologists, leading to unnecessary disparities in the standard of care and likelihood of response between patients. A significant proportion of patients with headache diagnoses do not receive the evidence-based treatments recommended in national or international guidelines,2 and substantial numbers of patients are not receiving preventive therapies.3 Ziegeler et al. found that a third of patients reporting to a tertiary headache centre had not received preventive therapy in line with guidelines, and half had never been prescribed a preventive treatment.2 Considering that 46% of the global adult population are estimated to have a headache disorder,4 this lack of a consistent, evidence-based approach is somewhat incongruent with the patient socio-economic impact. It is probable that lack of adherence to current headache guidelines is a multi-faceted issue. This variation in treatment (and therefore patient outcome), although unexplored,2 is not likely to be a simple educational issue. To add to this, an educational approach, in the form of seminars and workshops, does not have entirely positive evidence to support its use in implementing changes to patient care.5 It seems more probable that there are also structural issues within the health service that in some way preclude patients with headache disorders from gaining appropriate care. For example, using only doctors to care for patients with such a common condition may cause bottle-necking in access, and may not be an appropriate use of clinical resource. The current context of a global pandemic has shown us the importance of using the skillsets of all NHS staff working together for patient care. For headache care this could involve greater use of nursing colleagues or allied health professionals such as Pharmacists. To facilitate such an aim, an easily used and standardised approach is essential. We believe that the guidelines from the British Association for the Study of Headache (BASH),6 could facilitate such an approach.

Navigating the Labyrinth of Integrated Clinical Training in Neurology: a guide for the uninitiated

The National Institute for Health Research (NIHR) Integrated Academic Training (IAT) programme was introduced following recommendations within a 2005 report made by the Academic Careers Sub-Committee of Modernising Medical Careers and the UK Clinical Research Collaboration.1 This report highlighted the need for a more transparent academic career trajectory for trainees, with clear entry and exit points, and need for flexibility to be built into medical training to allow for research time. Now, more than fifteen years later, the NIHR IAT programme is well established, and arguably the best-recognised route for combining clinical and academic training in a given specialty. The protected research time provided by these posts is invaluable for pursuing scientific projects, acquiring any relevant technical or statistical skills, and for planning next steps, including applications for research funding. In this article, our aim is to demystify the application and interview process for NIHR Academic Clinical Fellowships (ACFs) and Clinical Lectureships (CLs); we will also discuss how these positions fit within the clinical academic pathway. This article is an amalgamation of theoretical facts and our practical experience, written in the context of neurology training, but might also be of relevance and interest for other medical specialties. Whilst we have chosen to focus on NIHR posts in this article, as these are most commonly encountered and advertised, some academic centres also offer locally funded ACF and CL posts; details can often be found on the relevant university website.

The Queen Square Brain Injury Clinic

There is recognition of the need for rehabilitation after TBI, but less for expert diagnosis at the level of pathology and impairment during rehabilitation. To minimise disability and cost and to maximise function, rigorous diagnosis of pathology and its consequences is required. A multidisciplinary Brain Injury clinic can provide a one-stop assessment, triage and subsequent follow-along for patients in the community after moderate-severe traumatic brain injury and enables prescription of the right treatment at the right time.

Mild parkinsonian signs: the interface between aging and Parkinson’s disease

Mild Parkinsonian Signs (MPS) describe a spectrum that exists between the expected motor decline of normal aging and a more serious motor deterioration resulting from Parkinson’s disease (PD) and neurodegeneration. Although MPS are a feature of the prodromal stage of PD, their formal definition is unclear and still relies somewhat on conventional clinical criteria for PD. This review will summarise the early motor features of PD and methods of assessment, from conventional clinical scales to advances in quantitative measures. Finally, the boundaries of motor decline as part of normal aging and pathological neurodegeneration will be discussed.

How to Prepare for the SCE in Neurology

A significant milestone in specialty training and necessary in the road to becoming a Consultant Neurologist, the Specialty Certificate Examination in Neurology is a useful opportunity for revision and improvement of clinical knowledge and clinical reasoning skills but can be an anxiety-inducing experience for many trainees. Here we provide a collection of resources and tips that were useful in our own preparation for the SCE. This is still based on our personal experiences and represents a biased view so bear this in mind when you are constructing your own tailored revision plan! We apologise if in places we are stating the obvious, but we hope this will be of use to those contemplating the exam from different locations and circumstances.

Hypnotic interventions in the management of chronic pain

This article describes the pain neuro-matrix and shows how hypnotic suggestions can be used directed at each part of this in order to be maximally effective. Although inducing the hypnotic state may be relatively simple, it is important to know how to utilise it effectively using suggestion and imagery. An understanding of the patient’s clinical condition and some counselling or psychological training are essential.

Ethnicity and multiple sclerosis - moving beyond preconceptions

Historically, multiple sclerosis (MS) was thought to be substantially more common in individuals from European ancestral backgrounds. Recent studies have challenged this preconception, with a concerning increase in incidence in Black British and African American individuals. In this review we provide a brief overview of the evidence for ethnic variation in MS risk, summarise potential explanations for this variation, and illustrate how these observations could be used to provide potential insights into disease biology.

How to Prepare for the SCE in Neurology

Gait, the way that we walk, requires complex cognitive functions. Gait may be a useful early marker for dementia diagnosis, as gait impairments precede and reflect cognitive decline. Early diagnosis of dementia enables individuals and their families to make informed decisions about their care plans, and allows researchers to understand preclinical and prodromal disease stages, providing novel targets for drug therapies. As such, a range of biomarkers are being developed to improve early and accurate diagnosis, including gait analysis. This editorial will outline how gait analysis can support the clinical diagnosis of dementia, including evidence of unique signatures of gait which can aid the identification of cognitive impairment and discrete dementia disease subtypes, the potential use of wearable technology to assess gait in the clinic and the real world, and key recommendations for the future implementation of gait into the diagnostic toolkit for dementia.