The NHS faces an ongoing, unprecedented challenge to reduce health budgets in England without compromising patient care. England has a ratio of 1 neurologist to 117,000 of the population (Headache Services in England 2014) ensuring only the most appropriate patients are referred to neurology services is paramount in terms of avoiding wasted cost, time or patient earnings. Other wider considerations must also be factored in which include the implications of delaying access to clinical input for those patients with more serious neurological conditions e.g. Parkinson’s disease. Health provision for headache services can be both improved and made more cost-effective, simultaneously saving capacity in overstretched neurology outpatient and A&E departments (A Report of the All-Party Parliamentary Group on Primary Headache Disorders 2014).

        Headache types

This can be achieved by supporting and educating Primary Care to manage patients in the community and addressing educational needs in Emergency Departments (ED). Headache disorders are most prevalent amongst working age adults and subsequently place a huge burden on the economy. 97% of headache is managed in primary care (Latinovic et al: 2005) and 3% of headache referred to secondary and tertiary centres. This 3% referral leads to >25% of neurology new out-patient load (Patterson & Esmonde: 1993).


The majority of patients are seen in secondary care once by a general neurology consultant; in many cases, this referral is to exclude secondary causes such as tumours.
Data from several reports highlights headaches as a key commissioning issue, in terms of high admission rates, high cost and potentially avoidable co-morbidities. There are significant gains to individual sufferers, the NHS and the economy by addressing early identification, diagnosis and management of headaches (A Report of the All-Party Parliamentary Group on Primary Headache Disorders 2014).

The decision to address headache management across the Yorkshire & Humber SCN is based on recognition that:
(1) service provision is variable;
(2) headache; patient pathways are frequently not well delineated;
(3) referrals into secondary care are often inappropriate for the following reasons:

  •  inappropriate in terms of severity of condition (usually only one assessment is required to exclude more serious conditions)
  •  the unnecessary demand on clinical time/reduce clinical appointments
  •  in terms of patient time, travel, experience and expense
  •  Subsequently the costs for headache services are high



(4) Publication of the neurology data sets earlier this year, includes information on headaches (Link to Neurology Intelligence NetworkNIN Image





(5) NICE headache quality standards 2012

APPG Headaches report
(6) across England, 83,000 headache suffers will miss work or school every day, equal to 20 million lost days of productivity each year (A Report of the All-Party Parliamentary Group on Primary Headache Disorders 2014). Publications Headache Services In England, A Report of the All- Parliamentary Group on Primary Headache Disorders 2014 (accessed 17/10/2014) British Association for the Study of Headaches (BASH)



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