As Migraine Awareness Week gets under way today (21st September 2026), GIRFT has launched the first national online pathway and decision-making tool for the care of patients presenting with headache symptoms, supporting GPs and pharmacy colleagues to offer good headache management and care.
GIRFT has worked with a large multidisciplinary group of expert clinicians to develop the interactive standardised pathway, with input from organisations including The Migraine Trust, the Royal College of General Practitioners, the British Association for the Study of Headache, the Royal College of Pharmacy, the Association of British Neurologists, the Royal College of Emergency Medicine and the Society of Acute Medicine.
The simple click-through format guides GPs, pharmacists and pharmacy counter staff through assessment, management and treatment options (where appropriate), based on national standards and best evidence. It includes red flag signs for urgent escalation and how to identify headache caused by the overuse of painkillers.
In accordance with the ‘digital-first’ approach to healthcare, this online pathway will form the basis of an upcoming digital-first headache pathway. A further online pathway for patients presenting in urgent and emergency care settings is also in development.
Join our webinar
GIRFT is hosting a national webinar on Wednesday 4 November 2026 12.30 -1.30pm, to demonstrate the headache pathway in action. We’ll also hear from colleagues in primary care, pharmacy and secondary care on the importance of the pathway, as well as hearing the patient perspective.
Register for our pathway for headache care webinar >
Headache symptoms account for 2-3% of all primary care consultations and are the leading cause of emergency department visits and unplanned hospital admissions for neurological issues.
Headache disorders also represent the largest group of conditions seen in neurology outpatient settings; around 20% of all appointments.
For most presenting patients, their headaches are benign (in many cases, migraine) but the symptoms can be disabling. The WHO Global Burden of Disease Study 2021 ranked migraine as the third leading cause of years lived with disability globally, only behind low back pain and depression.
GIRFT has worked for eight months to develop the interactive pathway, and stakeholder collaboration has been extensive. The aim is to support better and earlier care of patients with headache and migraine; streamlining patient journeys, reducing delays in care and improving equity across England. This in turn can reduce inappropriate secondary care referrals and free up capacity for other patients.
Dr Niranjanan Nirmalananthan, GIRFT’s joint clinical lead for neurology, said:
"This is the first nationally approved clinical headache pathway tool in England, offering one single point of reference for non-specialists to support evidence-based and optimal headache management and care.
Widespread adoption of the pathway by GPs and pharmacy colleagues has huge potential for improving the patient experience, helping to ensure earlier diagnosis, equity of access to services but also ensuring only those who need the support of secondary care are referred.
I'd urge everyone involved in the initial care of patients with headache to look at the pathway and bookmark it so they can access it quickly and easily to assess the best course of action."
Rob Music, chief executive at The Migraine Trust, said:
"Migraine can impact every aspect of life, from education to family life, career opportunities to life experiences. The theme for this year's Migraine Awareness Week is ‘Believe Me’ as we campaign to end the stigma around migraine.
We hope this important pathway is widely used to better understand migraine to diagnose patients who live with it and support them with appropriate treatment quickly."
Professor Alex Sinclair, chair of the British Association for the Study of Headache (BASH), said:
“BASH is delighted to see GIRFT’s new headache pathway for England, which gives doctors, pharmacists and allied health professionals a clear, consistent and evidence-based approach to assessment and management, putting practical guidance at their fingertips, streamlining care and supporting better experiences and outcomes for patients.”
