12th May 2021

The Migraine Trust’s Nurse Specialist

An interview with Ria Bhola, The Migraine Trust’s nurse specialist, to mark International Nurses Day 2021

As we mark International Nurses Day (12th May 2021), The Migraine Trust is highlighting the contribution of headache nurses to our work.

We interviewed Ria Bhola, a headache nurse and The Migraine Trust’s temporary nurse specialist, about her work. 

Ria Bhola

What does the work of a headache nurse entail?

The headache nurse’s work is broad and focuses on the education and management of patients who have been diagnosed with a primary headache disorder such as migraine or cluster headache. We will typically see patients at review appointments for medication management, to support and help them understand their diagnosis and empower them to live better with the condition as well as administer treatments. During consultations (virtually or in person), we talk about the disorder, how to treat acute attacks, how to take and optimise acute and preventive treatments, taking into account each person’s headache pattern and lifestyle. We also administer treatments like nerve blocks, botulinum toxin A (Botox) injections, calcitonin gene-related peptide (CGRP) monoclonal antibodies, non-invasive devices and manage withdrawal of overused painkiller medication.

What are the most common issues that your patients experience?

Patients struggle terribly in a number of ways. From having unpredictable attacks and being unable to plan their lives well, to the increasing frequency and severity of symptoms, treatments that do not work, ongoing daily pain that limit function, difficulty in obtaining a diagnosis and appropriate treatment and managing migraine in the presence of other underlying conditions. For those of us working in the headache specialty, it is disappointing to see the struggle patients face, often years, to obtain a diagnosis and treatment. We often refer to the vast unmet needs of headache patients, which has such a devastating impact on such a large scale. Patients also experience a range of side effects of treatments (many of which were designed to treat other conditions), and the limitations this presents. An important role of the nurse is to provide support and reassurance on what is available and realistic and empower our patients to have a better outcome.

What does a typical day at The Migraine Trust look like for you?

I work within the information and support services team to plan and explore better ways of empowering people affected by migraine and help them access the most appropriate care and treatment.

The Migraine Trust does not offer medical treatments. However, I would typically answer clinical questions, similar to the type of questions that a specialist nurse would be asked in a headache clinic. Many enquirers feel ‘at the end of the road’ when it comes to migraine. They will typically have chronic migraine and have tried several treatments that haven’t worked. Some may have seen a neurologist though not always a headache specialist. They ask about new treatments, how to access them and what they could do in the meantime.

I am also involved in other activities, from contributing to policy aspects such as the National Institute for Health and Care Excellence (NICE) appraisal of new treatments to writing for The Migraine Trust’s publications and other publications to expand knowledge to the wider community.

Why is it important to have the expertise of a headache nurse on The Migraine Trust’s team?

Migraine is a complex condition that is as yet under-diagnosed and under-treated. People with migraine need to be equipped to communicate effectively about their condition, to receive the correct diagnosis, understand what treatments are available and access the care and treatment they need. Having the expertise of a specialist nurse at The Migraine Trust aims to bridge that gap in service need and service provision, for everyone with migraine. We want to foster better relationships between the person with migraine and their doctor or nurse and to provide people affected by migraine, the best evidence-based information, advice and support.

People who Ria has helped

Ria has made a big difference to our work supporting people affected by migraine.

Recently, an enquirer got in touch with us. They had lost control of their migraine and it was really affecting them. They had tried many different preventives in the past and one of them had ended up causing an addiction. They were afraid of trying preventives again because of addiction and medication overuse headache.

Ria provided this person with the expert information they needed. She advised on regaining control of their migraines through using preventives, while managing medication overuse headache and suggested the possibility of asking for a referral to a headache specialist. This left the enquirer feeling much more confident to talk about their condition and ask for help. Before, they had felt anxious about speaking to their GP. Now they felt empowered to do so.

Another enquirer had a range of challenging symptoms and was unsure if they were related to hemiplegic migraine or epilepsy. They were due to be seen by specialists, but wanted another opinion on what they were experiencing.

The symptoms sounded more like epilepsy, but Ria highlighted the possibility of having both epilepsy and migraine. She also suggested treatments that would be beneficial. Ria also highlighted the importance of a review by a neurologist to ensure that all conditions were appropriately managed. This person is now being seen by a specialist and having a full review to work out what is going on and help them find appropriate treatment.