Interview with a headache nurse
What does a headache nurse do?
We meet Jill Murphy, headache nurse at York Hospital, to ask about her role in the care of migraine and other headache disorders.
What does a headache nurse do?
I work at York Hospital in the neurology out-patient department four days a week. I have five headache clinics a week which includes a weekly Botox clinic for patients with chronic migraine.
The majority of people I see have a diagnosis of migraine, often chronic migraine, but I also see people who have medication overuse headache, tension type headache, and other rarer headaches belonging to the group of headaches collectively known as trigeminal autonomic cephalalgias, which includes cluster headache and paroxysmal hemicrania.
Most of my patients are seen by a neurologist first and then followed up by me.
If the diagnosis is uncertain or complex, I will take another headache history to try and gain a better understanding of the symptoms, including the duration, the frequency, severity and the level of burden experienced by the individual. I will make a diagnosis and discuss the treatment options with my patient and then provide a treatment plan.
My aim is to educate and empower people to feel confident in managing and treating their headache type.
The four areas I encourage people to work on are:
- Improving their diet and lifestyle
- Rationalising their acute treatment frequency
- Aiming for a therapeutic dose of preventive medication
- Introducing complementary therapies.
I work within a team of two physiotherapists who provide acupuncture and physical therapy and a psychologist who can help people to understand and deal with the complexities of pain.
What difference does having a headache nurse make to your headache patients and the clinic you work in?
I can be the first point of contact for my headache patients. This is often quicker than waiting for an appointment to see their GP. I follow up with people more regularly and have longer appointments than the doctors. This can ease the burden for the neurologists too. I am able to instigate medication, alter the dose, instigate treatment plans and withdraw treatment; I can advise GPs to refer my patient to other agencies or hospital specialist as required. I work with the patient and aim to provide a positive outcome.
It would be fair to say that most people don’t like taking medication; this is generally because of side-effects. I explain side-effects and try to tailor the medication to suit the individual, using the side-effects in a positive way, as well as taking into account the headache diagnosis.
I provide information leaflets which explain the different types of headache, treatment and management. I write letters to employers and educational establishments explaining the burden of migraine with the aim of improving the work or study environment.
Local GPs can and do contact me for advice about treatments for different types of headache.
Are there any frequent or common concerns or worries that your headache patients express to you about their health condition?
Most people I see have had their headache or migraine for many years. People will generally consult their GP, or attend an Accident and Emergency (A&E) department within a hospital if there are new headache symptoms or their headaches become more severe. This causes worry and concern for the patient who in turn will seek reassurance. If this need is unmet, my patient will ask me if I think there is something sinister or worrying going on inside their brain. It can be difficult for people to believe that they can suffer so much pain and not have something seriously wrong with their brain. I will take another headache history about the new symptom or worst ever headache, and if I cannot reassure myself or my patient, I will discuss the patient with their neurologist to decide on the next steps. This may result in a review with the neurologist.
What are the greatest challenges of being a headache nurse?
There are not enough headache clinics and headache specialist doctors and nurses. People have to travel long distances to access the care that they need. I have a lot of patients who come to my clinics from out of the area; this places a greater burden on me to keep waiting times acceptable.
I can’t cure headaches, but I can help to improve them. I don’t have a magic wand; my patients have to work with me, and we are a team. The onus is on the patient to help themselves make a difference too.
Other challenges include:
Managing people’s expectations – most people have very low expectations based on their previous experiences. It can take time to get the treatment plan right; this will take perseverance by the patient to find the drug that works for them and may require regular visits in the initial stages to get the right treatment regime.
Overcoming barriers to care – misunderstanding familial beliefs; people often feel that they haven’t been taken seriously in the past; undoing learned negative behaviours.
Poorly managed migraine – getting the right treatment at the right time for it to be effective, but not taking acute treatments too often. I feel that getting this right can help to reduce A&E attendances.
What’s the most rewarding part of your job?
Meeting lovely people and being able to help them make a difference in improving the quality of their lives.
Working with people who are willing to do whatever it takes to improve their condition.
Empowering and educating people and their families to regain control of their headache and migraine, allowing them to live life the way they want to.
I am able to discharge people from my clinic when they feel better equipped to manage their headache and migraine.
Being part of a group of professional people all working towards the same goal, raising the awareness of the burden of headache and migraine and improving headache services.