Primary Care Migraine Services | Neurological Physiotherapy
New NHS plans shift migraine and headache care into community services
Shifting to the left: moving headache services towards primary care?
A new multidisciplinary policy paper has proposed a major redesign of headache and migraine services in the UK. Published in the British Journal of Neuroscience Nursing this paper outlines plans to shift most migraine services from hospitals into community and primary care settings.
Importantly, this is a proposal for service improvement, not an immediate nationwide change. However, it reflects growing momentum within NHS strategy toward delivering more care closer to home.
For the 10 million people in the UK living with migraine, the recommendations could represent a significant step forward if adopted.
The recent article Full policy paper: Ganesalingam J et al. Shifting to the left: moving headache services towards primary care? Published in the British Journal of Neuroscience Nursing (February/March 2026, Vol 22 No 1) was co authored by two of our physiotherapists Carla Horricks, Clinical Lead, and Joe Laverty, Specialist Physiotherapist, Neurological Physiotherapy.
Read the full article here:
Why Is Change Being Proposed?
Migraine remains one of the most common and disabling neurological conditions in the UK. Despite clear clinical guidance from the National Institute for Health and Care Excellence, many patients:
- Experience delays in diagnosis
- Are referred to secondary care without preventive treatment trials
- Face long waiting times for specialist neurology appointments
- Attend A&E during severe episodes
Recent NHS data shows rising migraine-related emergency admissions and increasing neurology waiting lists. The authors argue that this suggests migraine is often not being optimally managed early in the care pathway.
The paper proposes that strengthening migraine management in primary care could reduce unnecessary referrals, shorten patient waiting times, and improve patient outcomes.
What is the “Shift to the Left”?
The proposal aligns with broader NHS strategic goals from the Department of Health and Social Care and NHS England to move:
Care from hospital → community
Focus from treatment → prevention
Systems from reactive → proactive
In the context of migraine, the proposal suggests:
- Most migraine diagnosis and management taking place in primary care settings
- Only complex or refractory cases being referred to specialist neurology services
- Greater involvement of nurses, pharmacists, physiotherapists, and allied health professionals
- Improved patient education and self-management support
This model builds on work by the National Neurosciences Advisory Group and the Neurology Transformation Programme.
The Proposed Role of Physiotherapy in Community Migraine Care
The paper highlights multidisciplinary care as central to improving headache services. Physiotherapists are identified as key contributors within community-based pathways.
At Neurological Physiotherapy, we already work within this model of care.
Carla Horricks, Clinical Lead and Joe Laverty, Specialist Physiotherapist are part of the team at Neurological Physiotherapy who can support patients with complex neurological and headache presentations in community settings.
Physiotherapy can contribute to migraine management by:
✔ Assessing cervical spine and musculoskeletal contributors
✔ Managing cervicogenic and tension-type headache overlap
✔ Supporting posture and movement optimisation
✔ Promoting pacing and lifestyle strategies
✔ Encouraging long-term self-management
The proposal recognises that strengthening non-medical roles could improve capacity and continuity of care in primary settings.
As migraine services increasingly shift into primary care, specialist neurological physiotherapists will play a central role.
Book an assessment with one of our specialists today.
What Would Need to Happen for This Proposal to Work?
The authors outline three key recommendations:
Make Headache a Priority for Integrated Care Boards (ICBs)
Using local data to demonstrate how improved migraine management could reduce waiting lists and emergency admissions.
Address Funding and Prescribing Barriers
Regional variation in medication access and funding mechanisms would need clarification to enable safe transfer of care into primary settings.
Prepare the Workforce and Public
This includes improved migraine education for primary care professionals and expanded non-medical prescribing roles.
The paper stresses that primary care must be properly resourced, not simply given additional responsibility.
What Does This Mean for Patients Now?
At present, migraine care pathways vary across regions. The recommendations in this paper signal a possible future direction rather than an immediate service redesign.
However, many of the principles outlined – early intervention, multidisciplinary input, education, and prevention – are already being implemented in progressive community services.
At Neurological Physiotherapy, we support:
- Individuals with persistent migraine
- Cervicogenic headache presentations
- Postural and neck-related headache contributors
- Patients seeking non-pharmacological management alongside medical treatment
Community-based neurological physiotherapy aligns closely with the proposed direction of migraine service development.
Looking Ahead
The proposed “shift to the left” represents an opportunity to rethink how migraine care is delivered in the UK. If adopted and properly funded, it could:
- Improve early diagnosis
- Reduce hospital referrals
- Decrease emergency admissions
- Enhance patient education and self-management
- Deliver more equitable access to care
For now, it remains a strategic proposal- but one that reflects growing recognition that migraine deserves structured, proactive, community-based management.
If you would like to discuss your persistent headaches and migraine management please call now.
