Author(s): Dr. Munazza Shaikh and Dr. Rashmi Desarda
Abstract: Migraine is an extremely common symptom and collectively migraine disorders are among the most common of the nervous system disorders, with a prevalence of 48.9% in the general population.1 Migraine affects people of all ages, races and socioeconomic status and is more common in women. Some migraines are extremely debilitating and have significant impact on an individual’s quality of life, imposing huge costs to healthcare and indirectly to the economy in general. Only a small proportion of migraine disorders require specialist input. The vast majority can be effectively treated by a primary care physician or generalist with correct clinical diagnosis that requires no special investigation. Primary migraine disorders – migraine, tension headache and cluster headache – constitute nearly 98% of all migraines; however, secondary migraines are important to recognise as they are serious and may be life threatening. This article provides an overview of the most common migraine disorders and discusses the red flag symptoms that help identify serious causes that merit urgent specialist referral. The current pathway of migraine care in the UK is discussed with a view to proposing a model that might fit well in the financially constrained National Health Service (NHS) and with new NHS reforms. The role of the national society, the British Association for the Study of Migraine, and the patient organisations such as Migraine Trust in migraine education to the professionals and the general public in shaping migraine care in the UK is described. The article concludes by summarising evidence-based management of common migraine diagnoses.