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Minister Donnelly welcomes approval of new clinical pathway for headache

The Minister for Health Stephen Donnelly has welcomed a new clinically approved headache pathway, following a Sláintecare funded pilot project.

The new service for patients with headache and migraine was piloted across three Neurology centres in Galway University Hospitals, Tallaght University Hospital (TUH) and St James’s Hospital in 2020 and 2021 with funding from the Department of Health’s Sláintecare Integration Fund. The objective was to pilot a programme that joins up services across the hospital, community, and voluntary sectors.

The HSE has clinically-approved a new headache pathway for implementation across ten sites nationally. Planning has commenced in regard to funding and commencement of implementation at the remaining seven sites.

The service is led by the HSE National Clinical Lead Programme of Neurology in collaboration with the Migraine Association of Ireland, the Irish Pharmacy Union, and the Academic Unit of Neurology at Trinity College Dublin.

Minister Donnelly said:

"I am delighted to see that this excellent service is to be expanded to all neurology centres across Ireland. The purpose is self-care, and to ensure that assessment and management of headache and migraine takes place in the most appropriate setting. The multidisciplinary teams involved in this patient centred service are delivering on the Sláintecare reform objective of delivering the right care, in the right place, at the right time, by the right team."

Professor Orla Hardiman, National Clinical Lead in Neurology said:

"800,000 people in Ireland have a neurological issue, and there are 21,000 people on a waiting list for a neurological appointment in Ireland. Between 25% and 30% of people on those waiting lists were referred because of headache or migraine. Headache was the seventh most common reason for attendance at Emergency Departments, and the second most common reason for attendance at Medical Assessment Units."

The teams delivering the new service include neurologists, Clinical Nurse Specialists (CNS), Psychologists and targeted administrative support. The Migraine Association of Ireland (MAI) has partnered with the project to streamline services available to patients, especially psychology support groups in the community to facilitate self-care and long-term management of headache, thus reducing the need for ongoing engagement with hospital-based services.

Professor Hardiman adds:

"New patient pathways have been key to improving the patient experience, and for a timelier, more appropriate service for patients. If the ICGP headache management guidelines are not working, GPs can refer patients to a multidisciplinary specialist headache team. The team then works out a care plan with the patient and can refer for additional supports provided by the Migraine Association of Ireland where appropriate. Pharmacies have also been an important partner in the patient pathway, as they are often the first point of contact for people suffering from headache and migraine, and can provide invaluable advice to help with medication compliance.

The project has had a life-changing impact for patients who have accessed the service. Claire, who has suffered with migraine for seven years and attends the clinic in TUH said:

"I got a job in the last six months. It’s amazing, I never thought I would be able to work again, I can understand my migraines thanks to the service I’ve attended in Tallaght, and the Psychology Groups. It’s been really helpful in getting a job, my boss can understand my migraines, because I can understand and explain them."

The project is reducing the amount of repeat visits a patient makes to hospital. In Galway, for example, 171 patients have attended the GP Headache/Migraine clinic and only two return appointments have been arranged. Other achievements include:

  • 85 pharmacies have agreed to be involved in the pilot to date, exceeding the target of 20
  • over 300 patients have been referred to community pharmacies from three sites
  • the project has developed education leaflets and optimised the use of telemedicine
  • 37% of consultations were virtual between January and June 2021 due to COVID-19 restrictions
  • headache clinics have now been established with rapid access in TUH and St James’s Hospital with approximately 42 rapid access slots per month. The CNSs are available to support Emergency Departments and GPs to provide advice and education
  • nurse led clinics have been developed in St James’s and TUH, achieving the target of an increase of 20%
  • the Migraine Association of Ireland and psychology team have collaborated to run community group sessions and developed a series of video content and resources for those living with headache and migraine
  • the psychologists have developed new services with referral criteria and pathway. An eight-week group psychology intervention programme has also been established with three group interventions delivered to date
  • Patient Pathway Audit was completed between October 2020 and September 2021, details on 2,517 patients were captured. The data collated will help inform decision making with further development of the headache and migraine services in Ireland

Notes

Patient and staff spokespeople are available for this story.

Prof. Hardiman and her team recently participated in a Sláintecare webinar on the patient impact of the project.

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