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1 https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=3548800 2 https://www.nzherald.co.nz/features/news/article.cfm?c_id=543&objectid=6905 Bringing better neurological care for all Dr Wijeratne heads up local and international research projects that focus on finding better ways to offer neurological care in public and private health systems. “I think the disparities in health care need to be addressed, and that’s my grand mission. Where I practice in Melbourne, Victoria this is done very well. Victoria has a population of close to five million with around 15 health networks. To my knowledge, it is the only state in Australia where you will have access to a stroke service combining tele-medicine and local facilities, no matter where you were admitted. You will also be given access to the latest available technologies. So if you need a blood clot removed, you will be air-lifted to a place where that can be done.” Dr Wijeratne explains that to help drive improvement, a dedicated group has focussed on service delivery, education, and research that readily translate into better care. This group includes people based at hospitals in Auckland and Christchurch. The burden of migraine According to papers recently published by the group, migraine is the leading cause of disability in both Australia and New Zealand. Migraine affects about 15 percent of the adult population and is three times more common in women, due to hormonal factors. An estimated 5 to 10 percent of children also suffer from migraine. 1 The economic cost of migraines to New Zealand’s economy is an estimated $80 million a year, which equals 700,000 lost working days. 2 “The problem with migraine is it affects people who are working. It does affect retired folks as well, but to a lesser extent. As a result, the cost to the economy is huge. Unfortunately, migraine is also the least respected and worst managed medical disorder worldwide.” Improving the accuracy of diagnosis Because migraine is such a neglected malady, a lot of other disorders are misdiagnosed as headache disorders and vice versa. “I probably have at least six or seven young patients in Melbourne who attended top notch stroke centres and got a diagnosis of migraine, while they were actually having a stroke. On the other hand, doctors in the emergency department sometimes make the wrong diagnosis of stroke when patients actually have migraine.” The large number of different headache disorders only adds to the challenge of diagnosis. With the growth in obesity, Dr Wijeratne has seen a significant increase in pressure headache disorders, known as idiopathic intracranial hypertension or pseudotumour cerebri. Although their prevalence is still relatively low, they have the potential to cause permanent loss of vision if not diagnosed correctly. Sometimes the rare and excruciatingly painful cluster headache is also misdiagnosed as migraine, even though cluster headache symptoms are quite specific. “If you don’t identify the headache correctly, you can treat patients with the wrong medication or provide the wrong advice.” “I think that while we are making noise about migraine, it is equally important to recognise the other varieties of headache disorders that need treatment.” To help address the challenge, Dr Wijeratne and other medical professionals set up the Australia New Zealand Headache Society, which has representatives from both countries. They plan to hold their first annual scientific meeting in Melbourne this year. One of their first initiatives was production of a 35-minute video called ‘Out of sight, out of mind’. It’s available for free on YouTube. “The problem with migraine is it affects people who are working. It does affect retired folks as well, but to a lesser extent. As a result, the cost to the economy is huge. Unfortunately, migraine is also the least respected and worst managed medical disorder worldwide.” 12 Headlines