The process of developing quality indicators was not, in any of the studies, begun with, or therefore informed by, an agreed definition of ‘‘quality’’. What is surprising is that neither did these studies attempt to construct a definition, in the specific context of headache care, as a prerequisite for developing indicators of it. While quality is important in health care for any condition, and may to that extent have a general definition, there are aspects of it that are specific to or of particular importance in headache care. Furthermore, it is not clear that a universally accepted general definition of
quality of care does exist; even its attributes are not wholly agreed [4]. At issue here is whose perspectives matter in the
meaning and assessment of health-care quality: patients’, health-care providers’ or payers’? Assuming they all do to
an extent, and they are not perfectly aligned, which have priority? Quality is not necessarily coupled to financing:
there is no direct relationship between better outcomes and the amount spent on health care [41]. Improving the quality
of care for headache disorders goes beyond better diagnosis and good treatment, since large numbers of people with
headache do not consult doctors and hence will not benefit from improvements in care processes. There is clear evidence
of high barriers to care [2], and the need to dismantle them is high on the agenda for headache-service quality
improvement. Sorting out these issues appears to be a prerequisite for developing quality indicators for headache
services, but it has not been done.