Migraine: Diagnosis and Management from a GP Perspective

A quick reference guide for GPs treating patients for migraine - written in Ireland by Martin Rutledge neurologist, Esther Tomkins migraine nurse and Dr. Mary Kearney GP with a special interest in migraine.


(@turnitaround and @Onandon03 - you might want to move this doc to somewhere more appropriate)


Wow. Thx for sharing. That is a good one. Where have you been hiding that Karen. It certainly must be the most comprehensive treatment guide I’ve seen. I just wish UK GPs had been given it. Obviously as it is directed at educating doctors rather than patients it has a done what different slant to many others but so useful a read. I’ve only scan-read it so far so will have to go back. Funnily enough only a few minutes before you posted that I was telling my SO what thorough treatment you and Elaine seemed to have received in Ireland and that I was wondering about your Irish Health System. It certainly seems innovative and vibrant. And well ahead of its time. How’s it funded? Insurance maybe? Please post us a summary. I for one would be so interested to know, Helen

Hi Helen
Would you believe I was a patient of one of the doctors who authored that report and I didn’t know about it - I stumbled across it only last week while googling.
The public health system in Ireland (equivalent to your NHS) is not good - huge waiting times for appointments so I have paid to go private for all of my appointments. I do have private health insurance but it does not cover visits to consultants - I pay these out of my own pocket and it costs between €180-€300 per visit. Information here is pretty minimal on migraine too - a small number of neurologists here coupled with a relatively small migraine population = not a lot of info or places to turn. Elaine and I knew each other for many years prior to MAV and it was just good luck (for want of a better expression!!) that both of us ended up with this awful condition at the same time. We more or less joined forces, did a lot of research, shared information between us, made lists of questions so that each of us could grill whatever specialist we were seeing, we both pushed hard to be put on Venlafaxine after discovering that it’s a common and successful treatment in the U.S. (when we started on it last year it wasn’t a common drug in Ireland for migraine). We have shared our experiences with our neuros and GPs here on how this has worked for us especially for the dizziness in the hope that they can learn from our experiences and can help other patients who aren’t having success with the more commonly prescribed drugs or regimens. We also learned a HUGE amount about this illness on this forum from the regular posters here, I cannot emphasise enough how this forum has helped. It informed the questions I asked at my consultant visits, the med poll was a lightbulb moment for me - it made me ask for the drugs in the top 5 most used drugs, it made me understand the massive difference in taking an extended release versus immediate release drug (something the experts here don’t seem to consider when prescribing) the irony is not lost on me that the drugs I am on right now and am having massive success with are extended release versions and I had been on both of these drugs before but was on immediate release versions and I just couldn’t titrate to a therapeutic dose because of the side effects…imagine if I had been given the extended release of these 3+ yrs ago I would have been so much better soon after the onset. It is a beast of an illness but with the right neuro (one who absolutely believes in full symptom control) and the right drug or combo it can be beaten into submission. My current neuro absolutely believes in full symptom control and this spurred me on to try a combo and I am glad I did.


Thanks for the info.

However, we should make it clear:

  • this is copyright material, so strictly this should be linked, not uploaded without permission. Where is it hosted? Have we been granted permission?
  • this covers general migraine, not MAV. Whilst this is a contentious subject, I strongly suspect MAV is significantly more complex than non-vestibular migraine. I absolutely will not promote the unhelpful dogma that MAV is ‘just migraine’ which risks trivialising it to say the least. There are a few individuals that seem to follow this thinking. Imho they are wrong. However, wrt to treating the significant migraine element of MAV I respect it is very useful.
  • As it is targeted at general migraine and is copyright, I shall leave it here, but not promote it to the main Wiki. I’d be happy to add it to wiki links if we can find a reliable online link.

Hi Helen, this was funded by the migrane association of Ireland, they developed this guide in partnership with the folks mav mentioned. Every year this association apply for numerous grants to assist this type of intervention, it’s been years in the pipeline. Our GPS in short supply over here and swamped with work day to day, the liklihood of GPS using this are limited I’d say but if it even helps one ot two, then it’s a good thing.

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Thx for that Karen, kind of answers what would have been the next question how you or Elaine for that matter ended up on Venlafaxine as a first choice. So despite all their beautifully written blurb they let you choose. All linked to an enhanced chance of compliance they’d no doubt tell us if cornered.

Your system is obviously quite different from the UK although I paid privately fir almost everything as you did. On the NHS system I had Initial GP appointment, one CT Scan, two ENT consultant appointments, and I still have NHS access to the prescribed medications which means they are free at point of contact. I paid for the neuro-otologist, the MRI and both subsequent neurologist appointments, never have had any management type appointments even offered and most certainly never any discussions relating to prognosis/achieving total control or not or anything of that sort. I’ve read Dr Silver talking of the importance for full control for 6-12 months before attempting to come off medication.

The condition has really been studied, so many individual opinions. Most medics run piecemeal with bits based on their own personal experience. For example my own GP who knows nothing of MAV will only use extended release Venlafaxine never short release. Not that she ever prescribes it for MAV. Again a personal experience. Better universal and comprehensive knowledge is long overdue it seems.

I must admit I wondered. Most GPs book of knowledge seems to close once they hit general practice and despite its title it’s hardly a quick reference guide.

Hi James
My apologies I didn’t even think about copyright or permission issues…it is hosted on www.icgp.ie website and the link to the specific document is as follows.

Please remove the document and add the link instead if that does not infringe on copyright.

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Thanks. I’ll add that to wiki.

I just looked up their Terms and Conditions - this is what it says about copyright…perhaps we are not allowed to even post a link to the document?

All copyright, trademarks and other intellectual property rights in www.icgp.ie (including the design, arrangement and look and feel) and all material or content supplied as part of www.icgp.ie shall remain at all times the property of the ICGP. In accessing the website, you agree that you do so only for your own personal, non-commercial use. You may not agree to, permit or assist in any way any third party to copy, reproduce, download, post, store (including in any other web site), distribute, transmit, broadcast, commercially exploit or modify in any way the material or content or for any other purpose without the ICGP’s prior written permission.

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Let’s just link. That’s acceptable use imho

Ok great thanks

The authors of this guide- worked on it voluntarily and it was not funded by any group. It is due an update in the light of the newer CPRG drugs

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