Practice variation in UK neurology management of episodic migraine (EM)

<h3>Objectives</h3> Assess current UK practices in EM patient pathway and understand barriers to following latest guidelines in neurology. <h3>Methods</h3> UK neurologists experienced in treating EM patients participated in a structured online survey between Nov-Dec 2023. Findings were analysed using simple descriptive statistics. <h3>Results</h3> The survey was completed by 74 UK neurologists seeing an average of 79 migraine patients per month. 38% respondents reported more than 60% referrals being inappropriate mainly attributed to lack of effective communication with primary care. Although majority of respondents refer to NICE (73%), BASH (57%) and regional (47%) guidelines for their management of EM, they felt a lack of timely updates, funding constraint and lack of capacity due to staff shortages were the main barriers for implementation. Majority of respondents were familiar with the newer therapies CGRP mAbs (82%) and gepants (74%), but only 30% reported prescribing CGRP mAbs ‘often’ and ‘very often’ to their EM patients, despite being NICE recommended. <h3>Conclusion</h3> The management of EM varies regionally in the UK. Despite NICE approval, few eligible patients receive novel therapies. Funding and resource constraint, along with inappropriate referrals from primary care were the main reasons for variability in care.