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Headache is common, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK).1 It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations.^1-4 Headache disorders are classified as either primary or secondary.⁵ Primary headache disorders are not associated with an underlying pathology and include migraine, tension-type, and cluster headache. Secondary headache disorders are attributed to an underlying pathological condition. Medication-overuse headache (MOH) is increasingly recognised as a problem and affects around 1% of the population worldwide, but can vary significantly between countries (0.5% to 2.6%).^6,7 In patients with MOH, migraine is the most common underlying headache disorder (approximately 80%).

Migraine is the most common severe form of primary headache.⁸ The Global Burden of Disease study ranks migraine as the fourth most common cause worldwide of years lived with disability in all ages and second in people under the age of 50.⁹ Prevalence is highest in women, but the prevalence of migraine in young men is increasing.¹⁵²

It is estimated that migraine costs the UK public economy around £12.2 billion a year.¹⁰

Higher prevalence of migraine in women is thought to be because of changes in hormone levels during the menstrual cycle, which can be more pronounced at puberty and perimenopause. Before puberty, migraine frequency is the same in boys and girls.¹¹ Following the menopause, migraine often improves.^11,12

Migraine is often underdiagnosed, misdiagnosed (for example, as sinusitis) and undertreated in both primary and secondary care.¹³ In a multicentre primary care-based study, more than 90% of patients presenting to primary care with headache had migraine.¹⁴

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