Multidisciplinary Approach to Optimize Patient-centered Delivery of Headache Care

Only 11.8% of people with migraine overcome the three barriers to care of consulting with a health care professional for headache, receiving an accurate diagnosis, and receiving minimally appropriate migraine treatment (1). Even if the number of headache specialists is growing, it is not enough to meet patients’ needs. Hence, it is our responsibility to help design systems that support access to headache care and mitigate the barriers to timely diagnosis and appropriate treatment. 

The Global Campaign against Headache team recommends structured headache services with 90% of the patients being taken care of by frontline primary healthcare professionals (2). The European Headache Federation (EHF) and Lifting The Burden (Global Campaign against Headache) recently recommended the integration of community pharmacists in the delivery of headache care, although more data is needed to develop practical plans for their integration in different local contexts (3). Years of patient-led legislative advocacy in Ireland have given rise to the successful Towards Self Care in Headache program in ten major hospitals to improve headache outcomes and reduce hospital visits and costs by using existing resources within the community. Its components include: 1) implementation of nurse-led headache clinics 2) collaboration with selected community pharmacies to help improve diagnosis, management, referral, and support, 3) self-management training sessions and peer support groups in partnership with the Migraine Association of Ireland, 4) community-based headache education sessions for primary care practitioners (PCP), and 5) funding for a psychologist (4). Community health workers (CHWs) are frontline healthcare professionals who are trusted and engaged members of the community. CHWs can serve as a liaison between residents, healthcare services, and other available local organizations to help people optimize their health. Building on the success of CHWs to help with cardiovascular and other chronic disease screenings and management gaps in pharmacies, an article recently published in Practical Neurology describes ways to integrate pharmacy CHWs in the delivery of headache care to help with screening, management, and support (5). 

Part of headache advocacy is leveraging local resources and collaborating with other professions to improve access to timely diagnosis and appropriate migraine management. 

References: 

1. Buse DC, Armand CE, Charleston IV L, et al. Barriers to care in episodic and chronic migraine: results from the chronic migraine epidemiology and outcomes study. Headache. 2021;61(4):628-641. doi:10.1111/head.14103
2. Steiner, T.J., Jensen, R., Katsarava, Z. et al. Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description. J Headache Pain 22, 78 (2021). https://doi.org/10.1186/s10194-021-01265-z
3. BaniHani H, Lampl C, MaassenvandenBrink A, Amin FM, Carlsen LN, Coppola G, Deligianni C, Gil-Gouveia R, Holland PR, Husøy AK, Jensen R, Plácido M, Reuter U, Ryliškienė K, Sanchez Del Río M, Schytz HW, Tronvik E, Versijpt J, Steiner TJ. The role of community pharmacists in managing common headache disorders, and their integration within structured headache services: position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB: the Global Campaign against Headache), with the formal endorsement of the International Pharmaceutical Federation. J Headache Pain. 2025 May 6;26(1):100. doi: 10.1186/s10194-025-02021-3. Erratum in: J Headache Pain. 2025 Jun 16;26(1):139. doi: 10.1186/s10194-025-02073-5. PMID: 40329209; PMCID: PMC12054158.
4. Burke S, Barry S, Siersbaek R, Johnston B, Ní Fhallúin M, Thomas S. Sláintecare - A ten-year plan to achieve universal healthcare in Ireland. Health Policy. 2018 Dec;122(12):1278–82.
5. Begasse de Dhaem O, Logan RN, Galdo JA, Starling AJ. Integrating Community Health Workers Into Migraine Care. Community health workers serve as care extenders in screening, coordination, and management of migraine. Practical Neurology Sept/Oct 2025.