Headache service

• migraine disorders
• cluster headache
• paroxysmal hemicrania
• SUNA
• hemicrania continua
• paroxysmal headache disorders, e.g. cough, exertional, hypnic, thunderclap headache
• trigeminal neuralgia
• secondary headache disorders, e.g. headache related to changes in intracranial pressure, post-traumatic headache

All patients are supported by our clinical nurse specialists, who run follow-up outpatient clinics and telephone clinics, run clinics for local nerve blocks and botox, supervise admission for intravenous dihydroergotamine and caffeine, and liaise with the junior doctors on the Headache Service Firm who support the outpatients and inpatient services.

Most headache disorders are primary headaches, where the patient experiences recurrent headaches, without any obvious underlying cause. The most common disabling headache is migraine. This can be a life-long condition and is usually due to an underlying complex genetic predisposition, even if there is no obvious family history.

The goal of the headache service is to work with patients and their GPs to develop strategies to manage their headaches and to understand their disorder better. In our clinic letters we will provide a comprehensive assessment and management plan for the patient. A variety of medications may be suggested in the plan, along with instructions on how to initiate and titrate the doses.

If the management plan doesn’t achieve the required outcomes, the patient can be re-referred. For some patients, it may be necessary for them to have ongoing support from the local neurology department.

To avoid repeating treatments that have already been tried, please provide details of what has been used previously, the highest dose that was reached, for how long, the outcome and why the medication was stopped. Sometimes preventive treatments are not given at sufficient doses or enough time to work. In migraines, their action may also be impeded by concomitant over-use of acute treatments. Any acute treatment use should be restricted to eight days a month. Over use of acute medication has been shown to be behavioural, thus clinical psychology support can be invaluable in managing the overuse and the disability.

Patients should be encouraged to keep a headache diary so that their medication use and response can be monitored.

Please complete the Headache Referral Proforma to avoid delays in appointment allocation and to optimise use of the appointment.

Here are some resources that may be useful in understanding and managing headache.

• Daily headache diary
• BASH Guideline
• Referral form for primary and secondary headache
• NCL Headache Pathway Guidance

• To provide timely advice and treatment for patients referred for a tertiary† opinion
• To work in partnership with patients and health-care professionals to provide community based care
• To foster multidisciplinary co-operation between healthcare professionals
• To strive to improve our knowledge of headache disorders through research
• To improve awareness of headache

We are a dedicated specialist headache service based at the National Hospital for Neurology and Neurosurgery.

We manage all headache disorders and provide a comprehensive range of clinical services ranging from telephone clinics to inpatient admissions for diagnosis and treatment. We offer a wide variety of specialist procedures including intravenous infusions of caffeine and dihydroergotamine, local nerve blocks, botulinum toxin injections, occipital nerve and deep brain stimulation.

We also work in collaboration with other specialist teams to provide joint clinical services such as paediatric transition and neuro-otology headache clinics.

Where feasible we prefer to manage headache disorders as much as possible in the community, empowering patients through education. We also believe in providing shared-care management plans to work in partnership with GPs. This approach allows us to provide wider access to our specialist services while also minimizing the time between referral and clinic appointments.