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NHS Rightcare has developed a toolkit for optimising a headache and migraine care system5

The RightCare Headache and Migraine Toolkit: a pathway to provide clinicians with expert practical advice and guidance in order to:

  • address the challenges of migraine and headache prevalence, and the associated disability and impact on productivity
  • improve healthcare economics around migraine and headache
  • benefit the patient by reducing unnecessary healthcare visits and improving overall outcomes

The toolkit identifies four priorities for system improvement. Explore the following diagram to discover the key areas for focus in each priority:

System improvement priorities5

Correct identification and diagnosis
of headache disorders

Making appropriate referrals
to secondary care

Support patients to self-manage their
condition after diagnosis

Long-term management of patients in
primary or community care


The NHS Getting It Right First Time review of neurology gives recommendations for the management of common and chronic neurological disorders, including headache


BOTOX® (botulinum toxin type A) is indicated for the prophylaxis of headaches in adults with chronic migraine (headaches on at least 15 days per month of which at least 8 days are with migraine).6

CM: chronic migraine.

 

References

  1. Allergan. Data on file. INT/0423/2016
  2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
  3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
  4. Allergan. Data on file. 014
  5. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Available at: england.nhs.uk. Accessed April 2022
  6. BOTOX® Summary of Product Characteristics. Available at: medicines.org.uk. Accessed April 2022
 

Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.

 

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ 

Adverse events should also be reported to AbbVie on GBPV@abbvie.com 

 

Date of preparation: April 2022. UK-BCM-220078.

 

 

IDENTIFICATION AND DIAGNOSIS5

Healthcare practitioners to be supported and educated on the presenting symptoms of primary headache disorders (migraine, tension-type headache, cluster headache) and medication overuse headache:

  • to include utilising clinical champions and learning sessions

Patients to be given a positive diagnosis of a primary headache disorder after being assessed against standardised criteria:

  • use standardised assessment criteria, and provide an explanation of the diagnosis to the patient with reassurance that other pathologies have been excluded

Where a primary diagnosis cannot be made initially (and after the exclusion of secondary headaches) diagnostic decision making should be made over time by the application of a headache diary.

Prescribing information and adverse event reporting

Reference: 5. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed April 2022

APPROPRIATE SECONDARY CARE REFERRALS5

Patients should only be referred to secondary care for further investigation if their symptoms fall outside of the standard classification of primary headache disorders.

Education and awareness of healthcare practitioners on the signs of medication overuse headache (MOH) that do not require referral into secondary care:

  • to include training on signs of MOH and common features of primary headache disorders such as migraine

Consider implementation of referral support services to provide advice to healthcare professionals on the appropriateness of headache referrals to specialist outpatient neurology services.

Prescribing information and adverse event reporting

Reference: 5. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed April 2022

SELF-MANAGEMENT AFTER DIAGNOSIS5

Promote the use of headache diaries to understand personal triggers.

Provide information and education to people with a primary headache disorder on the risks and signs of developing medication overuse headache (MOH).

Utilise pharmacists to provide patient advice on MOH and appropriate use of analgesics.

Support the education of employers on the impact and effect of migraine at work:

  • Encourage communication between patient and employer and provide letters of diagnosis if required

Signpost people to third-sector resources including local support groups or national advice lines to reduce attendance at A&E departments.

Prescribing information and adverse event reporting

Reference: 5. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed April 2022

LONG-TERM MANAGEMENT IN PRIMARY OR COMMUNITY CARE5

Undertake shared decision-making with the patient on treatment options, including prophylactic treatment.

Personalised care plans to be agreed and in place:

  • Take into account individual needs and preferences, as well as comorbidities/ other risk factors

Manage primary headache disorders in primary or community settings and prescribe medication in line with NICE guidance:

  • Understand what services are available within the community, and ensure community-based services have sufficient training and support to manage patients with primary headache disorders

Refer patients to a community headache clinic or a GPwSI if they become resistant to treatment:

  • Define referral criteria and have a clear referral pathway

GPwSI: GP with special interest

Prescribing information and adverse event reporting

Reference: 5. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed April 2022