Health care system stymies effective migraine treatment

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Migraine is a common and disabling neurological disease, but the cost, availability and accessibility of care mean many patients are not getting effective treatment.

A University of Otago, Wellington—Ōtākou Whakaihu Waka, Pōneke, study interviewed primary care clinicians to find out how they manage migraine disease, including enablers and barriers to good care.

Co-author Dr. Jonathan Kennedy, a General Practitioner and Senior Lecturer in the Department of Primary Health Care & General Practice, says they found that people with migraine faced several significant barriers in accessing help.

“Primary care clinicians have the knowledge to effectively manage most people with migraine. However, existing problems in the health care system, such as cost, availability of appointments and waiting times—for both primary care and specialist neurological assessment—create barriers to help-seeking and management. This is especially the case for people who cannot afford private care and unfunded medications.”

Published in the Journal of Primary Health Care, the study found health care costs reduced initial engagement, along with follow-up and ongoing care; variation in access to specialist neurology care disadvantaged those who couldn’t access private services; and long waiting times and inability to register with primary care resulted in the perceived neglect of conditions such as migraine.

“This was particularly true among communities experiencing health care disparities, where a higher burden of other illness, combined with financial and discriminatory barriers, could put pressure on consultation time,” Dr. Kennedy says.

“We know disparities are greater when the primary health care system is based on reactivity, restricted availability and fees rather than relationships, trust, outreach and cultural safety.”

The study follows on from the Migraine in Aotearoa New Zealand survey, conducted by the Migraine Foundation Aotearoa New Zealand in 2022. The Migraine Foundation aims to raise awareness of the impact of migraine disease and support people living with migraine in New Zealand.

“We know from these studies that people’s physical and mental health, as well as work and quality of life, ends up suffering when appropriate treatment and specialist investigation and reassurance are not available, and that this increases pressure on primary care clinicians,” Dr. Kennedy says.

More than 750,000 people in Aotearoa New Zealand experience migraine, and it is 2 to 3 times more common in females.

Dr. Kennedy says the latest research affirms the need for investing in and growing the highly-skilled primary health care workforce and all the systems that support it, such as specialist outpatient services in Aotearoa.

“To improve health care outcomes and equity, both increased primary care availability and secure access to specialist advice and reassurance for patients and primary care clinicians are needed.

“Good understanding and up-to-date knowledge about migraine, for both primary care clinicians and people with migraine, helps ensure people are aware of treatment options and challenges stigmatizing beliefs about migraine being ‘just a headache.'”