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Migraine in Primary Care Advisors

MIPCA Projects

Logo: Headache UK - An alliance working for people with headache

Headache UK works to achieve recognition of chronic headaches as a major public health problem, to promote understanding of the significant impact headaches can have on the lives of people and to ensure speedy diagnosis and quality management for people who live with chronic headaches.

Organisation of headache services in the UK

Executive Summary


Government targets state that 75% of practices currently undertaken in secondary care will be transferred to primary care within the next 7 years. This will lead to the development of a primary care-led NHS, incorporating Primary Care Groups (PCGs) and Primary care Trusts (PCTs). Headache services need to be incorporated into this organisational framework.

However, there is much to do before this can take place. At present, migraine, cluster headache and other headaches are under-estimated, under-diagnosed and under-treated in the UK.1 Despite this, the personal burden of headache to the sufferer and the economic burden on society are high.2 In today’s primary care, the quality of headache services is unknown, and ad hoc service are generally performed on demand. Current headache services are neither adequate nor cost-effective, with no national or local targets, little research or auditing undertaken, a lack of interest among GPs and neurologists, few health professionals employed specifically in headache, and patients’ access to appropriate care restricted. Current NHS spending on the management of headache disorders is inadequate, unevenly distributed and not optimally managed.

This executive summary document recommends changes necessary to improve headache care in the UK. It is based on an initial document prepared in 2000 by the British Association for the Study of Headache (BASH).3


Headache UK proposes that headache services are re-organised in a stratified way, utilising local general practices more effectively, and by setting up primary and secondary care headache centres.


The principles of headache management we propose include:


Overall, several general initiatives are required to ensure the success of this proposal from Headache UK:


  1. Lipton RB, Goadsby PJ, Sawyer JPC et al. Migraine: diagnosis and assessment of disability. Rev Contemp Pharmacother 2000;11:63–73.
  2. Lipton RB, Stewart WF, Liberman J et al. Patterns of healthcare utilization for headache in England. Cephalalgia 1999;19:305 (Abstract).
  3. British Association for the Study of Headache. Review of the organisation of headache services in primary care and recommendations for change, 2000.
  4. Dowson AJ, Lipscombe S, Sender J et al. New guidelines for the management of migraine in primary care. Curr Med Res Opin 2002;18:414–39.
  5. Silberstein SD, for the US Headache Consortium. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;