GPs are the first port of call for most people when seeking help with their migraine, and they play a vital role in migraine diagnosis and management. Yet, too many people with migraine face delays in diagnosis, struggle to access appropriate treatment, and often feel unheard when seeking help.
Our research shows 39% had seen a doctor at least three times and 24% 6-10+ times before their migraine was diagnosed. Patients have told us they feel it is up to them to manage their migraine with 66% saying always and 23%.
We know that many GPs are confident in diagnosing migraine and supporting their patients in managing their condition.
“GP was very knowledgeable on migraine, gave really good advice and very supportive. Recent silent migraine attack and GP talked through symptoms, how to help prevent, treat etc”
However, our support services and patient surveys also show that many people’s primary care experiences are not always so positive. The Migraine Trust conducted a survey to understand patient experiences in primary care which highlighted areas in which greater support or resource may be required:
- Nearly 40% said they didn’t have any basic preventive treatment offered before a secondary care referral
- For those that were given treatment, 36% were not advised about increasing their dosage if the medication wasn’t working
- 67% weren’t advised to restrict their acute/rescue treatment in order to avoid medication overuse headache and 65% weren’t advised about the risks of medication overuse headache.
One patient told us, “poor migraine care from my GP led to unnecessary disability and job loss”; another: “GPs do not understand migraine. To them, it’s just a headache, and they have nothing to offer.” and another “I am a GP myself and I have felt completely abandoned by the NHS with this issue. I have had to self diagnose and self treat to a degree. It’s been shocking.”
We know that GPs are under unprecedented pressure at the moment and we fully support calls by the Royal College of GPs (the representative body for GPs) for investment in primary care and the GP workforce, to enable better access and more time for patients. The majority of migraine patients should remain in primary care and so it is vital that care providers feel equipped to deliver the diagnoses and treatment they need. Unnecessary referrals to neurology will create bigger backlogs in secondary care, where we are already seeing waiting lists rise significantly in the last two years.
If patients are not given treatment at the time they should, they risk their physical and mental health worsening, as well as the impact on aspects of life including finances and work.
To further understand how GPs could be better supported when providing migraine care, the charity surveyed GPs attending the Royal College of GPs’ annual conference last year. Many told us they would benefit from simple tools such as treatment flowcharts and short training modules to help them provide better care. They also highlighted specific areas where more training would be helpful, such as around newer treatment options and building confidence in spotting red flags, which potentially indicate a secondary cause for headache such as a tumour, compared to green flag symptoms supporting a migraine diagnosis.
This year we are conducting a larger survey of GPs to explore this in more depth. We are also currently calling for NICE (the body that provides guidance to the NHS) to update their guidance on migraine. The current guideline is seriously out of date, having been produced in 2012 when treatment and care for migraine was very different. For example it doesn’t include the use of Calcitonin Gene Related Peptide (CGRPs, which have been transformative for many able to access them.
Improving migraine care across the NHS is a priority for us at The Migraine Trust and ensuring GPs have up to date training on migraine care and the latest treatments is central to this. If you would like to share your experiences to inform our campaigns, or to help with our campaigns, please email campaigns@migrainetrust.org.
