Objective: To compare the ability of a headache nurse specialist and consultant neurologists in diagnosing tensiontype headache and migraine. Methods: An experienced neurology ward sister was trained in the differential diagnosis of headache disorders. Over six months, patients with nonacute headache disorders and role players trained to present with benign or sinister headaches were seen by both the nurse and a consultant neurologist. Both reached independent diagnoses of various headache disorders. Results: Consultants diagnosed 239 patients with tensiontype headache (47%), migraine (39%), or other headache disorders (14%). The nurse agreed with the consultant in 92%of cases of tensiontype headache, 91%of migraine, and 61%of other diagnoses. Where the nurse did not agree with the diagnosis, most would have been referred for a consultant opinion. Both the nurse and the doctors misdiagnosed the same three of 13 role players. The investigation rate of the consultants varied between 18%and 59%. Only one clinically relevant abnormality was found on head scans and this was strongly suspected clinically. Conclusions: A headache nurse specialist can be trained to diagnose tensiontype headache and migraine. A nationwide nurse led diagnostic headache service could lead to substantial reduction in neurology waiting times. Objective: To compare the ability of a headache nurse specialist and consultant neurologists in diagnosed tensiontype headache and migraine. Methods: An experienced neurology ward sister was trained in the differential diagnosis of headache disorders. Over six months, patients with non  acute headache disorders and role players trained to present with benign or sinister headaches were seen by both the nurse and a consultant neurologist. Both had independent diagnoses of various headache disorders. Results: Consultants diagnosed 239 patients with tension type headache (47%), migraine ( The nurse agreed with the consultant in 92% of cases of tensiontype headache, 91% of migraine, and 61% of other diagnoses. Where the nurse did not agree with the diagnosis, most would have been referred for a consultant opinion. Both the nurse and the doctors misdiagnosed the same three of 13 role players. The investigation rate of the consultants varied between 18% and 59%. Only one clinically relevant abnormality was found on head scans and this was strongly Silent clinically. Conclusions: A headache nurse specialist can be trained to diagnose tension- type headache and migraine. A nationwide nurse led diagnostic headache service could lead to substantial reduction in neurology waiting times.