Service Organization and Delivery
Stage 3 of the Campaign in various localities demands health-care solutions to the problem of headache as it exists locally. These solutions will generally depend either upon the planning and implementation of new headache services or upon improvement of those that currently exist, in either case seeking to achieve the best possible.
There are key questions: how should headache services be structured, organized and delivered: where, to whom, by whom, how much and with what objectives:
a) in well-resourced areas?
b) in medium-resourced areas (if differently)?
c) in poorly-resourced areas?
There is no agreement on how best headache services should be organized anywhere, although the British Association for the Study of Headache produced a consultation document in 2000 specifically for the UK National Health Service context, which focused on primary care.
As a template for well-resourced areas, Lifting The Burden has collaborated with a working group of the European Headache Federation to develop a set of recommendations. These propose organization on three levels (table).
Table. Headache services organised on three levels
| Level 1. General primary care |
· front-line headache services (accessible first contact for most people with headache) · ambulatory care delivered by primary health-care providers · referring when necessary, and acting as gatekeeper, to: |
| Level 2. Special-interest headache care |
· ambulatory care delivered by physicians with a special interest in headache · referring when necessary to: |
| Level 3. Headache specialist centres |
· advanced multidisciplinary care delivered by headache specialists in hospital-based centres |
Click here€ to view the pdf file Recommendations for headache service organisation and delivery in Europe.
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The model is potentially adaptable for less well-resourced countries.
In poorly-resourced areas, there may be little purpose in commitment of resources to exclusion of secondary headaches for which treatments are not available. Inability to treat these need not and should not be a barrier to treating primary headache and medication-overuse headache.
€Available June 2011