Primary care clinicians’ perspectives on migraine management in Aotearoa New Zealand: a qualitative study

Julia Randerson; Fiona Imlach; Jonathan Kennedy; Susan Garrett

doi:10.1071/HC25078

RESEARCH ARTICLE (Open Access)

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Primary care clinicians’ perspectives on migraine management in Aotearoa New Zealand: a qualitative study

Julia Randerson ¹ , Fiona Imlach

² , Jonathan Kennedy

¹ , Susan Garrett

¹ ^*

+ Author Affiliations

- Author Affiliations

¹ Department of Primary Health Care and General Practice, University of Otago, Wellington, Te Whare Wānanga o Otāgo ki Te Whanganui-a-Tara, PO Box 7343, Wellington South 6242, New Zealand.

² Department of Public Health, University of Otago, Wellington, Te Whare Wānanga o Otāgo ki Te Whanganui-a-Tara, Wellington 6242, New Zealand.

^* Correspondence to: sue.garrett@otago.ac.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care https://doi.org/10.1071/HC25078

Submitted: 9 May 2025 Accepted: 30 June 2025 Published: 5 August 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Despite being a common and disabling neurological disease, migraine is often underdiagnosed and undertreated. Although most patients with migraine can be effectively managed in primary care, people with migraine in Aotearoa New Zealand (NZ) report multiple barriers to care and negative impacts of migraine on physical and mental health, work and quality of life.

Aim

This study aimed to describe the experience of primary care clinicians with managing migraine disease in NZ and identify enablers and barriers to effective care.

Methods

Clinicians were recruited through advertisements in an online newsletter and a regional email network. Semi-structured interviews were completed via phone or Zoom. Inductive thematic analysis was undertaken to identify key themes.

Results

Five general practitioners and three nurse practitioners were interviewed. Themes related to the clinician, healthcare system and societal factors were identified across the patient journey of seeking health care (cultural safety, primary care accessibility, awareness and health literacy), diagnosis (diagnostic knowledge, secondary care and diagnostic test accessibility and diagnostic overshadowing) and management (treatment knowledge, communication and patient education, access to ongoing care, role of other health professionals and stigma of chronic disease).

Discussion

Significant barriers to migraine health care related to accessibility of primary care, particularly cost, wait times and availability. Advice from neurology was a valued resource, but access to in-person consultations for patients with migraine was limited. Clinician knowledge about migraine diagnosis and treatment was well supported by online and educational resources. Involving the wider primary care team in migraine management could help improve care.

Keywords: delivery of health care, disease management, health service accessibility, migraine disorders, New Zealand, primary headache disorders, primary health care, qualitative research.

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