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: 6. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed March 2024

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: 6. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed March 2024

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: 6. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed March 2024

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: 6. NHS RightCare. Headache and Migraine Toolkit optimising a headache and migraine system. Accessed March 2024