Despite the high prevalence of recurrent headache disorders—
principally migraine and tension-type headache—
and the substantial burden of public ill-health they generate
[1, 2], there are considerable variations worldwide in the
nature, scope, organization, quantity and quality of medical
care provided for these illnesses. At the same time, there is
good evidence that optimal care is rarely achieved. There
are multiple clinical, social and political barriers to both
provision of and access to effective headache care, a recent
publication by the World Health Organization stated: ‘‘The
facts and figures presented … illuminate the worldwide
neglect of a major cause of public ill-health and reveal
the inadequacies of responses to it in countries throughout
the world’’ [2]. In addition, and standing as a barrier to
improvement, it is not certain that there is a universal view
of what optimal headache services should look like, or,
indeed, of the meaning in this context of ‘‘optimal’’.