Building bridges in migraine management: consensus pathways on best practices across primary and specialist care in Italy

Introduction: Migraine is a disabling neurological disorder often mismanaged, with only a minority of individuals receiving a timely correct diagnosis and appropriate treatment. The aim of this work was to establish consensus-based indications for improving the management of individuals with migraine and optimizing their journey from general practice to specialist care. Methods: A panel of 17 Italian experts, including neurologists, pharmacologists, and general practitioners (GPs) assessed a total of 36 statements addressing migraine diagnosis and management in primary care, referral pathways, and long-term care through the Delphi methodology. Results: The panel endorsed the role of GPs in the early identification and management of migraine, emphasizing the use of validated screening tools and headache diaries as well as the adoption of structured care pathways, where available, to ensure consistent and effective management. Specialist referral was emphasized for chronic migraine, medication overuse, or for individuals with inadequate response to preventive therapies. The panel advocated for a shared, long-term care model grounded in dynamic, bidirectional collaboration across healthcare levels to reduce the burden on tertiary headache centers. Conclusion: This consensus provides practical, context-specific guidance to facilitate care of migraine across primary and specialist care. Proper implementation of this model may streamline the management of individuals with migraine, reduce diagnostic delays, prevent unnecessary costs, and ultimately guide the development of a coordinated migraine care model in Italy.