Migraine Care - FOI Response Register

We are asking all Health Boards about the care they offer for people experiencing migraine, as well as plans and training around this, in order to inform our campaigning and understanding of this issue. The attached Excel spreadsheet includes the questions and space for your response. I have also included the questions below but would be grateful if you could respond in the Excel template.

If it is not possible to provide the information requested due to the information exceeding the cost of compliance limits identified in Section 12, please provide advice and assistance, under Section 16 obligations of the Act, as to how I can refine my request. If any of this information is already in the public domain, please can you provide details of where it can be found together with page reference and URLs as appropriate.

Section 1: Commissioning and care planning                                                          

1. (a) Within the past year, have you reviewed or found opportunities for improvement in pathways and care for headache and migraine? 

No

1. (b) (i) If yes, what did this review find?

1. (b) (ii) If no, what has prevented this so far?         

Patients referred to General Medicine are seen within recommended parameters

1. (c) Do you have any plans to implement the findings of the optimum clinical pathway for adults for Headache & facial pain published by the National Neurosciences Advisory Group (NNAG) in February 2023?      

No though this would sit with NHS Grampian.

An FOI request to NHS Grampian can be submitted at the following address: gram.foi@nhs.scot

2. (a) Have you reviewed the migraine needs of your local population (e.g. numbers of people living with migraine who are diagnosed and not yet diagnosed) and planned services to meet these needs (e.g. by offering opportunities for training in migraine management to GPs, as well as adequate access to secondary and tertiary specialists) 

No

2. (b) If not, are there plans to do so?

No

3. (a) Do you plan to appoint a Migraine/Headache Lead in your area (e.g. to coordinate migraine care, share guidelines among colleagues, or lead needs assessments, service development and health care professional education across the area)?

No

3. (b) If not, are there alternative arrangements in place to coordinate migraine care?

NHS Grampian would provide this.

Section 2: Specialist headache clinics                                                           

4. (a) Do you have a specialist headache clinic in your Board area?                  

No

4. (b) (i) If yes, please give details.

4. (b) (ii) If no, please give details of the clinic you would refer out to.

NHS Shetland does not currently have a specialist headache clinic, these patients are usually seen within the general medical clinic.

5. (a) How many people did you support through your specialist headache clinics in 2021? 

See response to Q4 (b) (ii)

5. (b) How many people did you support through your specialist headache clinics in 2022? 

See response to Q4 (b) (ii)

6. What is the average waiting time from GP referral to first appointment at the specialist headache clinics in your Board area (current or for when you last had data)?

See response to Q4 (b) (ii)

7. How many full time equivalent (FTE) headache specialist doctors are employed by your Board area (in secondary care or GPs with an extended role)?    

None

8. How many FTE headache specialist nurses are employed by your Board area?

None

9. (a) Do you have plans in 2023/24 to increase headache specialist services?           

No

9. (b) If yes, please give details.        

Section 3: Access to Calcitonin Gene-Related Peptide (CGRP) medication

10. (a) Can eligible patients currently access Calcitonin Gene-Related Peptide (CGRP) medications through your Board area?   

Yes, through NHS Grampian consultant

10. (b) (i) If yes, how many people are accessing CGRP medication through your Board area?      

In accordance with FOISA s 17(1), NHS Shetland confirms that it does not hold the information requested because as mentioned in Q10 (a) this is accessed through an NHS Grampian consultant.

10. (b) (ii) If yes, which of the following CGRP medications can they access: Ajovy/fremanezumab, Emgality/galcanezumab, Vyepti/eptinezumab, or Aimovig/erenumab.

See response to Q10 (b) (i)

10. (b) (iii) If yes, what is the current waiting time to access a prescribing specialist?  

See response to Q10 (b) (i)

10. (b) (iv) If yes, is the administration of CGRP treatments monitored by a headache specialist

Yes, NHS Grampian

10. (b) (v) If yes, is the administration of CGRP treatments subject to any additional restrictions or criteria?                

Yes, as per NHS Grampian

10. (c) If no, do you refer and fund it out of area? Please give details.   

Section 4: Training

11. (a) Do you have any education or training programmes with GPs or pharmacists in your area on migraine? (E.g. regarding GP/pharmacy education, patient management in the community, patient information or referral pathways)       

No

11. (b) If yes, or if any are planned, please give details.                 

None

11. (c) If no, please explain any reasons (e.g. budgets / other priorities / other organisations' responsibility).    

Not a priority currently

Section 5: Inequalities

12. (a) Are you aware of local inequalities of access to headache specialist services amongst any groups (e.g. by gender, ethnicity, disability, socio-economic groups)?                    

No

12. (b) If yes, please give details of the inequalities and any work you are doing or planning to address this.