The National Institute for Health and Care Excellence (NICE) has issued standards to improve the care and support for young people and adults who suffer headache, including migraine.

Headaches are one of the most common neurological problems seen by GPs and neurologists. They may be tension-type headaches or migraine attacksⁱ (called primary headaches), or those caused by underlying disorders such as sinus infection, neck injury or stroke (called secondary headaches). Secondary headaches can also be associated with medication overuse. This happens when people take painkillers or triptanⁱⁱ drugs too often for tension-type headaches or migraine attacks. Doing this can reduce their effectiveness and cause further pain. An estimated 25 million days are lost from work or school to migraine each year in the UKⁱⁱⁱ, with more than 10 million people experiencing regular or frequent headaches. The impact may go further than the headache, causing significant anxiety between attacks.

The NICE quality standard is based on the NICE clinical guideline on headaches, and is designed to improve the diagnosis and management of headache disorders in people aged 12 years and older.

In summary:

• People diagnosed with primary headache disorder should have their headache type classified as part of the diagnosis, which will allow people to receive appropriate treatment and prevention for their particular headache. It is recognised that some people will have more than one type of headache and therefore may have more than one classification.
• Medication overuse is a cause of secondary headache in people with primary headache. People with primary headache disorder should be given information on the risk of medication overuse headache, which may prevent secondary headaches.
• People with migraine are offered combination therapy with a triptan and either an non-steroidal anti-inflammatory drug (NSAID)^iv or paracetamol. Correct treatment can relieve the symptoms of migraine and improve quality of life.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Headaches and migraine can have a very significant, negative impact upon those who suffer from them. It is important for people to understand that different headaches require different treatments, and so a correct diagnosis is vital. People may not know that overusing some types of medication for treating tension-type headaches or migraines can actually make things worse, causing further pain. This standard aims to raise the bar in the care and support for people with headache and migraine.”

Sam Chong, Consultant Neurologist and member of the committee which developed the quality standard said: “Headaches and migraine can be debilitating and distressing for those affected. Effective management of headaches depends on making a correct diagnosis and agreeing an appropriate treatment plan. Medication overuse headaches are a common problem; I hope this quality standard will go some way in raising awareness of this, and ensure that people with headache and migraine are getting the right treatment.”

Joanna Hamilton-Colclough, Director of Migraine Action, which endorsed the quality standard said: “As the national advisory and support organisation for people affected by migraine in the UK, Migraine Action has been delighted to be involved in the development of NICE's headache quality standard. We believe the standard is essential as part of the continuing process of recognising the huge impact of headache, both on individuals and wider society, and ensuring that those affected are informed about and have access to the most appropriate treatments based on current evidence, no matter where in England they are treated.”

The NICE quality standard for headaches in young people and adults is available on the NICE website from 00:01 hrs on Wednesday 28 August.

Ends

Notes to Editors

References

i. Migraine is a condition of recurring headache that may be linked with other symptoms, such as sensitivity to light and noise, nausea, vomiting, dizziness and eyesight changes. - Migraine Trust.

ii. Triptan medicines are not the same as painkillers. They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that is believed to be part of the migraine process. Triptans are available as tablets, injections and nasal sprays. - NHS Choices

iii. Migraine Trust

iv. NSAIDs are a medication widely used to relieve pain, reduce inflammation (redness and swelling), and bring down a high temperature (fever). - NHS Choices

About the quality standard

1. The NICE quality standard for headaches in young people and adults is available on the NICE website from 00:01 hrs on Wednesday 28 August.

2. The NICE quality standard for headaches in young people and adults is based on the following NICE accredited guideline:

• Headaches. NICE clinical guideline 150 (2012).

3. NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. They are derived either from NICE guidance or guidance from other sources that have been accredited by NICE, and apply right across the NHS in England.

Related NICE guidelines and quality standards

Published

4. Patient experience in adult NHS services. NICE quality standard 15 (2012).

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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