1. Getting to Grips with Headache European Headache Federation and The Migraine Trust

2. Headache in Primary Care David Kernick St Thomas Health Centre, Exeter Royal College General Practitioners Headache Champion International Headache Society Primary Care Lead Fellow NICE

3. What do GPs See? Kernick 2008 nSecondary headache 5% nTTH 21% nMigraine 72% nCluster 2%

4. The UK Prevalence of Migraine British Epilepsy Association; Diabetes UK; National Asthma Campaign; British Association for the Study of Headache

5. Impact of migraine nIn top 20 of WHO disability index n1000,000 people loose work or school each day nOver £2 billion cost p.a. in absenteeism Steiner 2003

7. University of Exeter Entrants Do you have headache that affects the quality of your life? n-1057 n212 (20%) headaches that affect Q of L nMajority had not seen a doctor Kernick 2002

8. Impact upon quality of life in school children n-1000 n20% 1 or more headaches each week that impacted nFor half of these - quality life score worse than asthma, diabetes, cancer Kernick 2009

9. What is happening? nLess than 50% migraineurs have sought help n3% of population have medication overuse headache nPoorly diagnosed and managed in primary care

10. What do GPs think when patients present with headache? n – 97,000 (Kernick 2008)

11. What is happening? In secondary care: n30%+ neurology referrals headache nApprox 50% investigated

12. What do patients want?

13. Information and explanation nClear information about diagnosis and treatment options nExplanations in terms that the patient can understand nAnd that make sense in terms of the patient's own story

14. Cure but not at all costs nRecognise that cures are not always possible nWant to cut down on medication: avoid side- effects and worried about diminishing effectiveness with long-term use nPractical advice about what to do for self-help

15. Non-abandonment nTime to talk from a health professional that takes them seriously nNeed for a safety net: not to be forgotten, dumped, abandoned, discharged

16. What do headache professionals think they need? BASH 2001 n GPs first line management n GPwSI support n Tertiary headache centres

17. Resouces nNICE guidelines nBritish Association for Study of Headache nMigraine Trust, Migraine action, OUCH nExeter Headache Clinic nMigraine Channel You Tube