Management of secondary chronic headache in the general population: the Akershus study of chronic headache
Espen Saxhaug Kristoffersen
0
1
Christofer Lundqvist
1
Kjersti Aaseth
1
Ragnhild Berling Grande
1
Michael Bjrn Russell
1
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
, PO Box 95, 1478, Lrenskog,
Norway
Background: The prevalence of secondary chronic headache in our population is 0.5%. Data is sparse on these types of headache and information about utilisation of health care and medication is missing. Our aim was to evaluate utility of health service services and medication use in secondary chronic headache in the general population. Methods: An age and gender stratified cross-sectional epidemiological survey included 30,000 persons 30-44 years old. Diagnoses were interview-based. The International Classification of Headache Disorders 2nd ed. was applied along with supplementary definitions for chronic rhinosinusitis and cervicogenic headache. Secondary chronic headache exclusively due to medication overuse was excluded. Results: One hundred and thirteen participants had secondary chronic headache. Thirty % had never consulted a physician, 70% had consulted their GP, 35% had consulted a neurologist and 5% had been hospitalised due to their secondary chronic headache. Co-occurrence of migraine or medication overuse increased the physician contact. Acute headache medication was taken by 84% and 11% used prophylactic medication. Complementary and alternative medicine was used by 73% with the higher frequency among those with than without physician contact. Conclusion: The pattern of health care utilisation indicates that there is room for improving management of secondary chronic headache.
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Background
The WHO initiated Lifting the burden: the global
campaign to reduce the burden of headache because
headache is common, under-diagnosed and undertreated [1-3].
The International Classification of Headache Disorders
2nd edition (ICHD-II) provides diagnostic criteria for
headaches which are divided into primary and secondary
forms [4].
The most common acute secondary headaches are
induced by alcohol, fever, hunger and rhinosinusitis and
are usually paroxysmal [5], but secondary chronic
headache ( 15 days per month 3 months or 180 days/last
year) is also common and medication overuse
contributes to the problem [6,7].
Most headaches are self-managed [8], but headache is
also one of the most common reasons for consulting a
general practitioner (GP) and accounts for 4% of all GP
consultations in the UK [9,10]. Approximately 20-30% of
all new referrals to out-patients neurological
departments are due to headache [9-12].
Headache has been suggested to be the most common
new neurological symptom presented [13], and many
neurological conditions include headache in the
symptomatology, thus it also represents an important
neurological differential diagnosis and may cause high use of
health care services.
Epidemiological data on secondary headaches are
largely lacking, and most information are from studies
that have not had a main focus on secondary chronic
headache. The International Headache Society`s
classification committee encourages further research in order
to provide more knowledge and information of
secondary headaches [4,14].
We have previously described the management of
primary chronic headaches in the general population [15].
Our aim here was to investigate secondary chronic
headache in the general population in order to evaluate utility of
health services and medication use.
Methods
Figure 1 shows a flow-chart of the study. The method
has been described in more detail elsewhere [6,15].
Sampling
A random age-stratified sample of 15 000 men and 15 000
women, 3044 years old and residing in the 20 eastern
municipalities in Akershus County, was drawn from the
National Personal Registry by Statistics Norway. Akershus
County has both rural and urban areas and is situated in
close proximity to Oslo.
Questionnaire
All persons in the sample received a mailed
questionnaire with a standard letter containing information
Figure 1 Flow chart of the participation.
about the project. Apart from ensuring confidentiality
and emphasizing the importance of participation, it was
stated that the object was to study headache. The
questions How many days during the last month have you
had headache? and How many days during the last year
have you had headache? were used to screen for chronic
headache. If the questionnaire evoked no response, a
second and subsequently a third reminder were issued.
Clinical interview, physical and neurological examination
The study took place at the Akershus University
Hospital in 2005. Persons with self-reported chronic
headache who also consented by adding their telephone
number on the questionnaire were invited to a clinical
examination. Self-reported chronic headache was
defined to be headache occurring 15 days within the
last month and/or headache occurring (...truncated)