Self-reported efficacy of complementary and alternative medicine: the Akershus study of chronic headache

The Journal of Headache and Pain, Aug 2013

Background Chronic headache is associated with disability and high utilisation of health care including complementary and alternative medicine (CAM). Findings We investigated self-reported efficacy of CAM in people with chronic headache from the general population. Respondents with possible self-reported chronic headache were interviewed by physicians experienced in headache diagnostics. CAM queried included acupuncture, chiropractic, homeopathy, naprapathy, physiotherapy, psychological treatment, and psychomotor physiotherapy. Sixty-two % and 73% of those with primary and secondary chronic headache had used CAM. Self-reported efficacy of CAM ranged from 0-43% without significant differences between gender, headache diagnoses, co-occurrence of migraine, medication use or physician contact. Conclusion CAM is widely used, despite self-reported efficacy of different CAM modalities is modest in the management of chronic headache.

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Self-reported efficacy of complementary and alternative medicine: the Akershus study of chronic headache

Espen Saxhaug Kristoffersen 0 1 Kjersti Aaseth 1 Ragnhild Berling Grande 1 Christofer Lundqvist 1 2 3 4 Michael Bjrn Russell 1 2 0 Department of General Practice, Institute of Health and Society, University of Oslo , Oslo, Norway 1 Head and Neck Research Group, Research Centre, Akershus University Hospital , Lrenskog, Norway 2 Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo , Nordbyhagen, Norway 3 HKH, Research Centre, Akershus University Hospital , Lrenskog, Norway 4 Department of Neurology, Akershus University Hospital , Lrenskog, Norway Background: Chronic headache is associated with disability and high utilisation of health care including complementary and alternative medicine (CAM). Findings: We investigated self-reported efficacy of CAM in people with chronic headache from the general population. Respondents with possible self-reported chronic headache were interviewed by physicians experienced in headache diagnostics. CAM queried included acupuncture, chiropractic, homeopathy, naprapathy, physiotherapy, psychological treatment, and psychomotor physiotherapy. Sixty-two % and 73% of those with primary and secondary chronic headache had used CAM. Self-reported efficacy of CAM ranged from 0-43% without significant differences between gender, headache diagnoses, co-occurrence of migraine, medication use or physician contact. Conclusion: CAM is widely used, despite self-reported efficacy of different CAM modalities is modest in the management of chronic headache. - Introduction Chronic headache, i.e. 15 days/month for 3 months or 180 days/year affects 3-4% of the general population [1,2]. Management of chronic headache is a challenge, since medications often do not alleviate it sufficiently. Thus, many patients seek or are referred to complementary and alternative medicine (CAM), such as acupuncture, chiropractic, homeopathy, naprapathy, physiotherapy, psychological treatment and psychomotor physiotherapy. The use of CAM is high both in Norway and worldwide [3,4], and about 1 of 3 uses CAM for headache in Norway [5]. A survey among CAM providers suggests headache to be one of the conditions where patients benefit most from CAM management [6], but reports of treatment efficacy from the patients are lacking. The aim of this study was to investigate self-reported efficacy of CAM in people with primary and secondary chronic headache from the general population. Findings Methods A cross-sectional epidemiological survey, including 30 000 persons aged 3044 years old stratified for age and gender, was drawn from the general population of eastern Akershus County, Norway. A short postal questionnaire screened for possible chronic headache (15days/last month and/or 180 days/last year). Screening-positive subjects were invited to a clinical interview and physical and neurological examination conducted by neurological residents. The criteria of the International Classification of Headache Disorders II (ICHD-II) were used with supplementary definitions for chronic rhinosinusitis and cervicogenic headache [1,2,7]. Chronic headache was defined as headache 15 days/months for at least 3 months or 180 days/year. Medication overuse headache without other secondary causes was classified as primary chronic headache. The Complementary and alternative medicine (CAM) forms queried included acupuncture, chiropractic, homeopathy, naprapathy (manipulation and stretching of joints and muscles), physiotherapy, psychological treatment and psychomotor physiotherapy. All CAM use was included independently on whether it was reimbursed or not by the National Health Insurance. Homeopathy and naprapathy is not reimbursed, while the other CAM modalities, in some selected cases, are partially or fully reimbursed from authorised providers. The participants were asked for ever-use, e.g. Have you ever tried/used/been to physiotherapy for headache? For questions of self-reported efficacy, participants were asked with reference to the CAM management tried for their headache: Did you experience any efficacy in terms of lasting reduction of headache frequency and/or intensity? A more detailed description of the material and methods has been given elsewhere [1,2,8]. Statistics Statistical analyses were performed using SPSS 20.00 (SPSS Inc., Chicago, IL, USA). For descriptive data, proportions, means and 95% confidence intervals (CI) are given. Pearson 2 test was used for testing significance of group differences for categorical data, Fisher`s exact test was used when appropriate. Significance levels were set at p<0.05. CI is not given when n <5. Ethical issues The Regional Committee for Medical Research Ethics and the Norwegian Social Science Data Services approved the study. All participants gave informed consent. Results 253/405 (62%) participants with primary chronic headache and 82/113 (73%) participants with secondary chronic headache had used CAM for headache. Table 1 shows the self-reported (...truncated)


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Espen Saxhaug Kristoffersen, Kjersti Aaseth, Ragnhild Berling Grande, Christofer Lundqvist, Michael Bjørn Russell. Self-reported efficacy of complementary and alternative medicine: the Akershus study of chronic headache, The Journal of Headache and Pain, 2013, pp. 36, Volume 14, Issue 1, DOI: 10.1186/1129-2377-14-36