Treatment access and self-management support for migraine in primary care: development of a feasibility study proposal for group consultations

Problem

Migraine is ranked as the most disabling health condition under the age of 50 years, affecting 1 in 7 people. Access to effective treatment of episodic migraine (EM) in primary care is important as inadequate acute treatment is a predictor of chronic migraine (CM). Emergency hospital admissions for headache have increased by 15% in England since 2012/2013 despite recommendations that migraine is treated in primary care. Waiting lists for neurology continue to grow. Group self-management interventions have been shown to be effective in patients with CM but the evidence in EM is less clear. This project aimed to identify patients’ priorities for research through patient and public involvement (PPI).

Approach

One to one discussions with migraine patients were held in a specialist headache clinic and a national migraine charity clinic. A discussion framework, developed previously with patients, guided discussions about patient and healthcare provider roles. Handwritten transcripts were typed by the author and analysed using an inductive approach to identify codes and these codes were grouped into themes. The themes then informed development of an online social media survey which asked patients to rate the importance of different types, providers and locations of support. The survey was publicised by national migraine charities through Twitter and Facebook after piloting. Findings were then discussed with the PPI group.

Findings

Discussions with 21 consecutive patients from the two settings were analysed. Four themes were identified: access to care, collaboration, prevention and treatment. Patients thought they had an important self-management role that centred on migraine attack prevention through leading “the right lifestyle”. They described what support was needed and was missing. Access to care was highlighted in most discussions as a problem. Collaboration between patients and clinicians was important: "have to use medical side and your side together”. The survey, completed by 221 respondents, rated decision making support, education and side effect knowledge as extremely important in > 80% of responses. The majority responded that self-management support should be provided by the NHS, located in the community and provided through group plus one to one support. Subsequent discussions with the PPI group have identified that evidence is needed as to whether group consultations for migraine address the problems identified.

Consequences

Patients’ identified support for their role along with better access to treatment as priorities for research. This has led to the development of a feasibility study proposal of group consultations for migraine. The expected outcome will be a manualised group consultation programme, a process evaluation and co-creation of video and written resources for use in primary care.