Getting to Grips with Headache

European Headache Federation and The Migraine Trust

Headache in Primary Care

David KernickSt Thomas Health Centre, Exeter

Royal College General Practitioners Headache Champion

International Headache Society Primary Care Lead

Fellow NICE

What do GPs See? Kernick 2008

Secondary headache 5%

TTH 21%

Migraine 72%

Cluster 2%

The UK Prevalence of Migraine

5.7

4.1

0.7

0 5 10 15Estimated prevalence (%)

Migraine

Asthma

Diabetes

Epilepsy

British Epilepsy Association; Diabetes UK; National Asthma Campaign; British Association for the Study of Headache

Impact of migraine

In top 20 of WHO disability index

1000,000 people loose work or school each day

Over £2 billion cost p.a. in absenteeism

Steiner 2003

University of Exeter Entrants

Do you have headache that affects the quality of your life?

n-1057

212 (20%) headaches that affect Q of L

Majority had not seen a doctor

Kernick 2002

Impact upon quality of life in school children

n-1000

20% 1 or more headaches each week that impacted

For half of these - quality life score worse than asthma, diabetes, cancer

Kernick 2009

What is happening?

Less than 50% migraineurs have sought help

3% of population have medication overuse headache

Poorly diagnosed and managed in primary care

What do GPs think when patients present with headache?

n – 97,000 (Kernick 2008) 0

20

40

60

80

100

Pe

rce

nta

ge

20 40 60 80 100Age

Cluster MigraineTension Secondary

Undifferentiated

What is happening?

In secondary care:

30%+ neurology referrals headache

Approx 50% investigated

What do patients want?

Information and explanation

Clear information about diagnosis and treatment options

Explanations in terms that the patient can understand

And that make sense in terms of the patient's own story

Cure but not at all costs Recognise that cures are not always possible

Want to cut down on medication: avoid side-effects and worried about diminishing effectiveness with long-term use

Practical advice about what to do for self-help

Non-abandonment

Time to talk from a health professional that takes them seriously

Need for a safety net: not to be forgotten, dumped, abandoned, discharged

What do headache professionals think they need?

BASH 2001

GPs first line management

GPwSI support

Tertiary headache centres

Resouces

NICE guidelines

British Association for Study of Headache

Migraine Trust, Migraine action, OUCH

Exeter Headache Clinic

Migraine Channel You Tube