getting to grips with headache european headache federation and the migraine trust
TRANSCRIPT
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Getting to Grips with Headache
European Headache Federation and The Migraine Trust
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Headache in Primary Care
David KernickSt Thomas Health Centre, Exeter
Royal College General Practitioners Headache Champion
International Headache Society Primary Care Lead
Fellow NICE
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What do GPs See? Kernick 2008
Secondary headache 5%
TTH 21%
Migraine 72%
Cluster 2%
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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
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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
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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
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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
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What is happening?
Less than 50% migraineurs have sought help
3% of population have medication overuse headache
Poorly diagnosed and managed in primary care
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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
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What is happening?
In secondary care:
30%+ neurology referrals headache
Approx 50% investigated
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What do patients want?
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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
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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
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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
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What do headache professionals think they need?
BASH 2001
GPs first line management
GPwSI support
Tertiary headache centres
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Resouces
NICE guidelines
British Association for Study of Headache
Migraine Trust, Migraine action, OUCH
Exeter Headache Clinic
Migraine Channel You Tube