Anne-Marie Logan, Consultant Physiotherapist in Headache, attended the BASH Hull meeting 2025 with support from a BASH bursary. She reflects on this event.
A Teams call to colleagues attending the European Headache Conference last year triggered a “FOMO” moment. I realised that I was missing out on the discussion about how our new migraine therapies were being used in services around the UK. I booked my leave and requested a place for the BASH Hull meeting. I wasn’t disappointed.
Global picture
I have worked in headache for a long time but occasionally it is good to step back and see the problem from a bigger perspective. Professor Mario Peres told us that only 8% of the world population do not have headaches, 75% of people with migraine do not take treatment, only 11% were on a prophylactic. That 1 million people are on an anti CGRP treatment shows how far we have come as a speciality in the last few years, but we still have a lot to do.
New therapies
It is wonderful to have a new range of therapies to support people living with migraine. I see each week the huge benefits that they have created for patients and regularly hear how treatments have changed patients’ lives.
We heard from Professor Rami Burstein from the Harvard Medical School, USA about how cortical hyperexcitability maybe critical for peripherally acting CGRP inhibitors. We also heard about Atogepant and its role in reducing spreading sensitisation through Aδ fibres. Professor Peter Goadsby spoke further about the premonitory phase in the hypothalamus, PAG and dorsal pons. It was good to be reassured that gepants do not appear to lead to Medication Overuse Headache sensitisation. Over the next few years it will be interesting to hear how treatment choice can be tailored to those with allodynia or prodromes. I always enjoy listening to Dr Phil Holland, from Kings College London. He spoke about how 75% of patients can predict their next attack by presence of fatigue which has led his team to start to look at this.
Women and children and migraine
It always surprises me that we don’t have whole headache meetings on migraine in women. As Professor Anne Macgregor told us, 1 in 5 women have migraine but the evidence is limited.
Two presentations on children, their co-morbidities and how they differ from adults were a treat. Dr Ishaq Abu-Arafeh’s phrase “Let’s give your mum/dad a rest and let’s hear what you have to say!” is highlighted in my notes for future use.
Networking
Every headache meeting is a chance to catch up and share experiences with colleagues and friends and this one was no exception. The new therapies have created a capacity issue which continues to challenge headache teams in the UK. Speaking to colleagues, the issues are the same across the board. Finding a 3-month appointment after treatment initiation is difficult. The different dispensing routes between oral and injectable treatments are confusing for clinicians and processing them is time consuming. The ongoing requirement for Homecare “wet prescriptions” shows how far behind we are as a nation in making our services more efficient and responsive. The lack of a consistent approach to pathways across ICSs causes inequity.
Despite no additional resources, there is a lot of change that needs to happen. The meeting reminded me how good it is to have great colleagues in other services alongside us as we make this journey.
Anne-Marie Logan
Consultant Physiotherapist in Headache
St George's NHS Hospital Trust, Tooting
