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)