Getting the right treatment for migraine can be difficult – the NHS is a complex organisation and sometimes there can be a lack of understanding about what treatments are available or when you are eligible to have them prescribed. We speak to many patients who feel “at their wits end” trying to get the right treatment and support to manage their migraine.

We want to help you to navigate the system at every stage and advocate for the best treatment for you.

We have information on the recommended migraine treatment pathway in the UK including acute and preventive treatment options.

Getting the right diagnosis from your GP

Getting an accurate diagnosis is a vital first step to getting the treatment and care you need.

Your GP should be able to diagnose your migraine but GPs are not necessarily migraine specialists. It can sometimes be hard to distinguish migraine from other headache conditions.

So that your GP is in the best position to identify migraine and offer the right support, it helps to tell your GP the following:

• when you experience headaches, how frequently, what they feel like and how long they last
• how bad your headaches are (eg, mild, moderate or severe, or on a scale of 1-10)
• any other symptoms you experience, such as feeling or being sick, sensitivity to light, sound or smells, dizziness or vertigo
• medication you have tried and whether it has helped
• any patterns or potential triggers you have noticed
• impact on your life and day-to-day activities.

Our headache diary can be a good way to record this information before seeing your GP.

If your GP does diagnose migraine, make sure they write it in your notes. This can help with getting the right care later on.

Management of migraine is based on clinical guidelines and the healthcare professionals involved in your care should follow these. Examples include:

• The British Association for the Study of Headache guidelines for headache management
• The National Institute for Health and Care Excellence (NICE) clinical guidelines for diagnosis and management of headache
• SIGN (Health Improvement Scotland) guideline on pharmacological management of migraine

These are trusted professional resources which give clear guidance on the symptoms of and treatments for migraine.

Seeking a second opinion

The General Medical Council requires doctors to respect a patient’s desire to seek a second opinion. If you have explained your concerns about your diagnosis to your GP, they should be willing to refer you to another doctor. This will usually be another GP at the same practice – but you could ask to be referred to a different practice if you would prefer.

You can ask your GP for a copy of your medical records, including their diagnosis or notes from your appointments. You have a right to these records, but it may take some time for them to be made available.

Access to treatments

There are many treatment options for migraine. What may work for one person may not be helpful for someone else.

Your GP should be able to recommend different treatments to see what works best for you.

This usually starts with acute medicines, designed to treat the symptoms of migraine attacks. If you get frequent migraine attacks or they are severely impacting your life, they may also recommend a preventive treatment.

Usually, if you try three different preventive medications and they do not help, you can be referred to a headache specialist or neurologist (depending on the protocols in your area).

If your medications are not working and you are not being offered alternatives, you can point out that, according to the , you have the right to be prescribed medication and treatment if NICE have recommended it for people in your situation.

Specialist Referrals

Waiting lists to see a specialist can be long. If you are struggling with a long wait, you could:

• Ask if it possible to have an ‘out-of-area referral’ to a specialist with a shorter waiting list. Under the NHS Constitution, you have the right to choose where you are treated
• If a referral is delayed significantly or refused, then the Patient Advice and Liaison Service (PALS) in England; Patient Advice & Support Service Scotland (PASS) or Llais in Wales can speak to you about any options that might be available to you 
• If you are really unhappy with your care, you can complain to your Integrated Care Board in England, your Local Health Board in Wales or Scotland or ni direct in Northern Ireland. Integrated Care Boards (ICBs) and Local Health Boards (LHBs) are groups of representatives from the NHS which decide how services in their local area should be run. Explain the impact that your inability to see a specialist is having on your life (for example missing work or affecting your wellbeing) and note that NICE guidance states that persistent migraine which cannot be improved with standard treatments warrants referral to a specialist.

Support for you

If you need to talk about any aspect of migraine, The Migraine Trust is here for you. Find out about our free support services