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Migraine in Primary Care Advisors

MIPCA Projects

Providing guidelines for patients

This project produced guidelines for the management of migraine by patients, both self-management and management in concert with healthcare professionals. The introduction of evidence-based guidelines in the UK has greatly improved the potential for the GP to successfully manage migraine in primary care.

This project has been extended to provide guidelines to help patients manage their migraine with the support of a multidisciplinary primary healthcare team (although in many surgeries, all consultations will be with a GP only).

The guidelines are divided into three parts:

  1. Headache is identified as a problem by the patient, who will then seek help from a patient support group, a GP, nurse or other healthcare professional. The patient is given a checklist to complete which provides information designed to help with headache diagnosis and management, and a specific appointment is made for them to see the GP about their headache.
  2. The nurse reviews the checklist, takes a history, provides appropriate information and elicits the patient’s commitment to the care process. The GP then diagnoses the patient’s headache and prescribes appropriate treatment. The nurse gives out a headache diary and impact questionnaire, and makes a further follow-up appointment. The headache diary provides prospective information on the evolution of the patient’s headache and the efficacy of treatments, and is designed to be particularly useful at follow-up consultations.
  3. At follow-up, questionnaires are reviewed by the nurse and the GP reviews the patient’s management. Further questionnaires are given out and the next appointment made. Clear roles are provided for the patient and healthcare professionals at pre-consultation, at the first consultation and at follow-up.

Where possible the patient should have access to a specialist headache patient following the initial consultation and follow-up. The specialist headache patient provides a link between the patient and the healthcare professional that is designed to improve patient education and commitment, and reinforce primary care services. If a specialist patient is not available the patient should be given contact details of a patient support group such as the MAA – www.migraine.org.uk. The overall aim is to provide a mechanism so that most headache patients can be managed in primary care in a team-based approach, with effective education and monitoring in place.

Reference

Turner A, Lipscombe S, Laughey WF et al. New guidelines and questionnaires to help patients manage their migraine. Headache Care 2005;2:151–62.

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