Project Coversheet

Date of Award


Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)




Elizabeth Portugal, DNP, APRN, NMW-C


Diane Monsivais, Ph.D., CNE, ANEF


Globally, headache disorders affect people of all ages, genders, and ethnic and socio- economic backgrounds. Recurrent headaches are responsible for poor quality of life, personal and social adversities, and increased financial burdens. Headaches are the most common complaint among neurological disorders, yet many are misdiagnosed and undertreated. In 2020, the U.S. Department of Veteran Affairs and the Department of Defense (VA/DoD) released an evidence-based clinical practice guideline (CPG), The Primary Care Management of Headaches. The objective of this quality improvement (QI) project was to implement the use of the VA/DoD CPG algorithm among clinic providers at a military primary care, patient-centered medical home located in the Southwest for patients aged at least 18 years who presented with a complaint of headache. Before implementation of this CPG, no standardized practice existed for diagnosing and treating headache disorders at the clinic. Diagnosis and treatment of headache disorders were often left to the individual providers discretion, not evidence-based practice. The aims of this QI project were to standardize the management and treatment of headache disorders among primary care providers, improve provider efficiency, and improve overall patient outcomes. Providers’ adherence to the CPG was measured using headache diagnosis codes from International Statistical Classification of Disease and Related Health Problems, 10th edition (ICD-10). The results showed a decrease in the use of unspecified headache and other headache diagnoses as well as an increase in specific headache diagnoses postimplementation in 3 of the 6 clinic providers. Improvement was noted in ICD-10 headache coding practices by all clinic providers after repeated in-person in-service trainings. CPG use is an effective way to disseminate evidence-based recommendations into clinical practice. However, sustainment will require ongoing education.

Included in

Nursing Commons