Opinion

A major headache

10 January 2022

Some 10 million people in the UK are affected by migraine. Una Farrell of The Migraine Trust looks at how healthcare should change to better help them.

Migraine is highly prevalent in the UK. With 10 million people living with the condition (NHS England, 2020), it’s something that community practitioners (CPs) may frequently encounter and help people with.

This is because a CP may be the first healthcare professional that people talk to about their migraine symptoms. Many patients often don’t know that they have migraine, mistaking it for sinus pain or a bad headache. However, CPs and other health professionals with a good understanding of migraine and its symptoms can recommend that patients go to their GP to be properly assessed.

Primary care by a GP is where most migraine patients are diagnosed and treated; this is often effective, even though there is no cure. However, people are likely to wait a long time for a diagnosis, and are often obliged to manage their migraine themselves.

The Impact of MigraIne

People with migraine can face serious consequences if they are not treated effectively. The Migraine Trust’s recent Dismissed for too long report revealed the legacy of pain and damaged lives caused by migraine and people not getting the help they need (The Migraine Trust, 2021).

The lack of adequate treatment is bad for the NHS too: there were 108,711 emergency admissions for headaches and migraine in 2018/19, and it is estimated the cost to the NHS of treating migraine is around £150m (NHS England, 2020). Nearly 16,500 emergency admissions for headaches and migraine attacks could be avoided with the right care pathways, and £11.5m could be saved on non-elective admissions (NHS RightCare, 2019).

Key healthcare problems

However, it is not only in primary care that migraine patients are struggling; another key issue is lack of access to specialist care. Most migraine patients never see a headache specialist – even those who are referred to neurologists often see one that has no expertise in the condition.

Additionally, only a small minority of local NHS systems (26 out of 154 contacted) reported that they had a specialist headache clinic. Although not every migraine sufferer will need to see a specialist, far too many are being denied the expert help they need.

These long-standing problems have only intensified over the past year. Many people eligible for new calcitonin gene-related peptide (CGRP) monoclonal antibody medication – the first drugs specifically developed to prevent migraine – have struggled to access them, even though the medication is approved for use on the NHS.

The Migraine Trust submitted Freedom of Information requests to all NHS trusts in England, Health and Social Care trusts in Northern Ireland, and health boards in Scotland and Wales; the replies showed that only a small number were allowing eligible patients access to CGRP treatment: as few as 15 out of 128 trusts in England, for example.

Primary care recommendations

Although problems with migraine care exist throughout the healthcare system, many can be addressed in primary care.  

This is therefore a key priority for change. Primary care is where most people with migraine are seen but also where the pressure is most felt on the NHS. To help GPs deal with that pressure, we recommend that:  

  • Everyone attending primary care for head pain should be assessed for migraine, with the assessment outcome recorded.
  • Migraine treatment and care should be a core part of junior doctor and GP training to make accurate and rapid diagnosis easier and lead to better patient outcomes.
  • If someone is diagnosed, they should receive an individualised care plan, developed in partnership with them. Regardless of whether medication is prescribed, they should regularly review this care plan with their doctor.

In addition to solutions focused on those giving and receiving care, we believe migraine should be properly prioritised from the top of healthcare systems. Integrated care systems in England, trusts in Northern Ireland, and health boards in Scotland and Wales should review their migraine needs and plan services to meet them. They should also appoint a migraine/headache champion, share guidelines among colleagues, and take the lead on needs assessments, service development and healthcare professional education.

If someone tells you they have symptoms that could be migraine, urge them to go to their GP for assessment

How can CPs help?

It is important CPs understand the symptoms of a migraine attack and how it can be a whole-body experience – particularly for children, whose migraine can present as abdominal pain.

If someone tells you they have symptoms that could be migraine, urge them to go to their GP for assessment. You should also recommend that they start a headache diary to record their symptoms, as well as their length and frequency. That will help their GP’s diagnosis and help identify the type of migraine they have (see Resources).  

Also, encourage them to talk to their doctor about how their symptoms are affecting them, their ability to learn and work, and how they socialise and do the things they enjoy. This will help their doctor understand the impact migraine is having on their life.

Finally, we want migraine to be better known and understood to break down the myths and stigmas associated with it. National awareness campaigns and workplace guidance will help start this important process.

The change that’s needed

None of our report’s recommendations are revolutionary: they are straightforward solutions that we have developed with care professionals and people living with migraine. However, they will have far-reaching benefits for all people affected by migraine and for the NHS, the economy and society as a whole. That’s why change must happen urgently – the UK’s migraine sufferers have been dismissed for far too long, and they should not have to put up with inadequate healthcare any longer.  

Una Farrell is communications manager at The Migraine Trust.


Resources  


Time to reflect

How can you help if a client tells you that they are having frequent headaches or that the pain makes their lives increasingly difficult to live? Join the conversation on Twitter @CommPrac and use #migrainesupport


References

Migraine Trust. (2021) Dismissed for too long: recommendations to improve migraine care in the UK. See: https://migrainetrust.org/wp-content/uploads/2021/09/Dismissed-for-too-long_Recommendations-to-improve-migraine-care-in-the-UK.pdf (accessed 30 November 2021).

NHS England. (2020) Improved NHS migraine care to save thousands of hospital stays. See: england.nhs.uk/2020/01/improved-nhs-migraine-care/ (accessed 30 November 2021).

NHS RightCare. (2019) Headache and migraine toolkit. See: england.nhs.uk/rightcare/products/pathways/headache-and-migraine-toolkit/ (accessed 30 November 2021).

Image credit | iStock

 

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