Management of primary chronic headache in the general population: the Akershus study of chronic headache

The Journal of Headache and Pain, Mar 2012

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. Acute headache medications were taken by 87%, while only 3% used prophylactic medication. GPs manage the majority of those with primary chronic headache, 1/5 never consults a physician for their headache, while approximately 1/5 is referred to a neurologist or hospitalised. Acute headache medication was frequently overused, while prophylactic medication was rarely used. Thus, avoidance of acute headache medication overuse and increased use of prophylactic medication may improve the management of primary chronic headaches in the future.

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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 - 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)


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Espen Saxhaug Kristoffersen, Ragnhild Berling Grande, Kjersti Aaseth, Christofer Lundqvist, Michael Bjørn Russell. Management of primary chronic headache in the general population: the Akershus study of chronic headache, The Journal of Headache and Pain, 2012, pp. 113-120, Volume 13, Issue 2, DOI: 10.1007/s10194-011-0391-8