Introduction

Headache is one of the commonest problems seen in both primary and secondary care:

General Practice: 4.44 consultations/100 registered patients
Neurology: 20-25% of referrals

Global Burden of Disease study ranks headache disorders as the second leading cause of years lived with disability worldwide

One-year prevalence of headache disorders is 50%:

Episodic tension type headache: 41% female, 40% male
Episodic migraine: female 18%, male 6%
Chronic daily headache: female 5%, male 3%

Migraine alone is the leading cause of disability among people aged 15 to 49 years

In UK, an estimated 10 million people aged 16-65 experience migraine
190,000 migraine attacks are experienced everyday, 100,000 are absent from work or school everyday, contributing to 43 million lost work or school days every year
94% of primary care consultations for headache are due to migraine
- Yet migraine is often not recognised and <20% of patients with migraine attain a diagnosis
Costs of migraine to UK: £8.8 billion

Pathway recommendations

This pathway is has been developed to aid the assessment, diagnosis and management of common primary headache disorders and give guidance on when to consider secondary headache disorders.

Patients with headache disorders access care across the NHS and this pathway is intended to be relevant to those working across primary care including community pharmacy and general practice and those working across secondary care including emergency care, acute/general medicine and neurology.

It is split into 9 sections to allow easy access:

Overview: National referral pathway; red, amber and green flag; diagnosis of common primary headaches; life style advice and useful guidelines
Acute treatment of migraine: relevant to primary and secondary care
Preventative treatment of migraine: migraine prophylaxis accessed in primary care and specialist options available in secondary care
Open access CT from primary care, including information on incidental findings
Management of migraine in pregnancy and lactation: including pre-conception advise
Management of menstrual and peri-menopausal migraine
Management of medication overuse headache
Cluster headache
Indomethacin sensitive headaches

References and further resources

Vos T, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Lancet. 2017;390:1211–1259.
Steiner T. All Party Parliamentary Group on Primary Headache Disorders, 2008
Tepper S, et al. Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache. 2004 Oct;44(9):856-64.
Kernick D. GPs' classification of headache: is primary headache underdiagnosed? Br J Gen Pract 2008; 58: 102–104.
Latinovic R, et al. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. JNNP. 2006;77(3):385-7 https://www.lancaster.ac.uk/media/lancaster-university/content-assets/documents/lums/work-foundation/SocietysHeadacheTheSocioeconomicimpactofmigraine.pdf

gjnh.cfsdpmo@gjnh.scot.nhs.uk