Management of primary chronic headache in the general population: the Akershus study of chronic headache
J Headache Pain
Management of primary chronic headache in the general population: the Akershus study of chronic headache
Espen Saxhaug Kristoffersen 0 1 2 3
Ragnhild Berling Grande 0 1 2 3
Kjersti Aaseth 0 1 2 3
Christofer Lundqvist 0 1 2 3
Michael Bj?rn Russell 0 1 2 3
0 C. Lundqvist H?KH, Research Centre, Akershus University Hospital , L?renskog, Oslo , Norway
1 E. S. Kristoffersen General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo , Oslo , Norway
2 E. S. Kristoffersen R. B. Grande K. Aaseth C. Lundqvist M. B. Russell (&) Head and Neck Research Group, Research Centre, Akershus University Hospital , 1478 L?renskog, Oslo , Norway
3 M. B. Russell Institute of Clinical Medicine, Akershus University Hospital, University of Oslo , Nordbyhagen , Norway
Primary chronic headaches cause more disability and necessitate high utilisation of health care. Our knowledge is based on selected populations, while information from the general population is largely lacking. An age and gender-stratified cross-sectional epidemiological survey included 30,000 persons aged 30-44 years. Respondents with self-reported chronic headache were interviewed by physicians. The International Classification of Headache Disorders was used. Of all primary chronic headache sufferers, 80% had consulted their general practitioner (GP), of these 19% had also consulted a neurologist and 4% had been hospitalised. Co-occurrence of migraine increased the probability of contact with a physician. A high Severity of Dependence Scale score increased the probability for contact with a physician. Complementary and alternative medicine (CAM) was used by 62%, most often physiotherapy, acupuncture and chiropractic. Contact with a physician increased the probability of use of CAM.
Primary chronic headache; Chronic migraine; Medication-overuse headache; Health care utilisation; General population
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Headache is a common complaint in the general
population. The personal burden, social impact and economic cost
for both the sufferer and society are significant [1]. The
International Classification of Headache Disorders
(ICHDII) divides headaches into primary and secondary forms
[2]. The most common primary headaches are migraine and
tension-type headaches, while other primary headaches are
rare [3]. The primary headaches are usually paroxysmal,
but 3% of the general population has primary chronic
headache, i.e. more than 15 headache days per months [4].
Headache accounts for 4% of the general practitioners
(GPs) consultations, and 2?4% of these are referred to
specialists or hospitals [5, 6]. Headache is probably the
most common reason for referral to neurologists [5?7].
Approximately 20?30% of all new referrals to out-patients
neurological departments are due to headache [5, 6, 8, 9].
Our aim was to investigate primary chronic headache in
the general population in order to evaluate utility of health
services and medication use, since this knowledge is
generally lacking.
This is a cross-sectional epidemiological survey. A short
postal questionnaire screened for chronic headache
(C15 days/last month and/or C180 days/last year).
Participants with self-reported chronic headache were invited to
a clinical interview, a physical and neurological
examination conducted by neurological residents. The response rate
of the screening questionnaire was 71% and the
participation rate of the interview was 74%. Figure 1 shows a
flow chart of the study. The method has been described in
more detail elsewhere [4].
The study was conducted in 2005 at Akershus University
Hospital, Oslo, Norway. Provision of health care in
Norway is based on a decentralized model. The state is
responsible for policy design, overall capacity and quality
of health care and hospital services. Almost all general
practices are private enterprises and their services are
contract based. The GPs are reimbursed through a fixed
annual fee, and fees for the specific services from the
Fig. 1 Flow chart of the participation
National Health Insurance and the patients. Each
Norwegian citizen has through legislation the right to be on a GPs
list, and it is possible to change GP twice a year. The GP is
the gate keeper for referral to specialists and hospitals
except in emergencies.
A random sample of 30,000 persons aged 30?44 years and
stratified for age and gender was drawn from the general
population of eastern Akershus County, Norway. The area
includes rural and urban municipalities in close proximity
to Oslo.
Headache classification
The headaches were classified according to explicit
diagnostic criteria of the ICHD-II and its relevant revisions, i.e.
the latest update was used in relation to chronic migraine
and medication overuse headache [2, 10?12]. Primary
chronic headache was defined as headache at least 15 days
per months for at least 3 months, not secondary to a head
trauma, brain tumour, etc. Those with medication overuse
as defined by I (...truncated)