Quality standard


This quality standard covers the diagnosis and management of the most common primary headache disorders (tension-type headache, migraine and cluster headache) and medication overuse headache in adults and young people aged 12 years and older. For more information see the topic overview.

Why this quality standard is needed

Headache disorders are classified as primary or secondary. The cause of primary headaches is not well understood and they are classified according to their clinical pattern. The most common primary headache disorders are tension-type headache, migraine and cluster headache. Secondary headaches are caused by underlying disorders and include headaches associated with medication overuse, giant cell arteritis, raised intracranial pressure and infection. Medication overuse headache most commonly occurs in people taking medication for a primary headache disorder. Headaches are one of the most common neurological problems presented to GPs and neurologists.

Most of the health and social burden of headaches is caused by primary headache disorders and medication overuse headache. An estimated 25 million days are lost from work or school because of migraine each year[1]. Headaches not only have an impact on the person during a headache; the anticipation of a headache can cause significant anxiety between attacks.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcome framework published by the Department of Health:

Table 1 shows the outcomes, overarching indicators and improvement areas from the framework that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2013/14


Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition**

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care (i) GP services

Alignment across the health and social care system

** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Coordinated services

The quality standard for headache in young people and adults specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole headache care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to young people and adults with headache.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality headache service are listed in Related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare practitioners involved in assessing, caring for and treating young people and adults with headache should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

[1] Migraine Trust (accessed August 2013) Key facts and figures about migraine.