The management of migraine in primary care is, of necessity, a long-term business. Patients need to be evaluated and treated carefully over a period of time. The physician's time and energy can be conserved during this process by using other healthcare providers to form a primary care headache team. The physician, practice nurse, ancillary clinic staff and sometimes a pharmacist provide the core team. Pharmacists, community nurses, opticians, dentists and complementary practitioners can all feed patients into the team, while the physician can refer the patient to a specialist physician if necessary:

• The physician can concentrate on the patient's diagnosis and initial and follow-up treatments, referring them to a specialist, if necessary.

• The practice nurse can conduct much of the communication with and evaluation of the patient before they see the physician, and may also meet migraine sufferers serendipitously during their regular duties.

• Pharmacists, community nurses and other primary healthcare providers can help with the identification, education and initial treatment of headache sufferers, and advise appropriate sufferers to consult their primary care physician.

• Pharmacists can also explain when drugs (acute and prophylactic) can be taken, and answer patients' concerns about side-effects and possible interactions with other products.

• Good communication needs to be established between the specialist and primary care physicians. The specialist needs to inform the primary care physician of their diagnosis and treatment choices, as much of the future management of these patients devolves into primary care. the specialist does not have to be a consultant physician. A primary care physician or Primary Care Trust (PCT) specialist with expertise in headache may also be appropriate.

• Last, but not least, the patient is an important member of the team, and must be included in the treatment decision-making process. The patient needs to be able to discuss their headache history, understand their diagnosis and management plan, and what it is likely to achieve, agree to the course of therapy and feel motivated to continue with long-term treatment.

In practice, there is a core medical team of the primary care physician, practice nurse and their assistants. Pharmacists, community nurses, opticians, dentists and complementary practitioners form associate members of the team. The patient can access medical care from any member of the team, who will refer them to the primary care physician if necessary. The specialist physician then forms an additional resource for the primary care physician to use where necessary. Such a team can work without a formal organisation, providing all members are educated about headache and its treatment. In practice, this is often not the case, and there is a good argument for a more formal agreement between healthcare professionals on headache care in the community. For the healthcare professional with an interest in headache, help can be gained from one of the many professional organisations that deal with headache research and treatment in the UK, e.g. Migraine Trust (www.migrainetrust.org), MIPCA (www.mipca.org.uk), BASH (www.bash.org.uk) and the Migraine Action Association (www.migraine.org.uk).

http://www.medscape.com/viewarticle/446557_4