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

The Journal of Headache and Pain, Mar 2013

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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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. - 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)


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Espen Saxhaug Kristoffersen, Christofer Lundqvist, Kjersti Aaseth, Ragnhild Berling Grande, Michael Bjørn Russell. Management of secondary chronic headache in the general population: the Akershus study of chronic headache, The Journal of Headache and Pain, 2013, pp. 5, Volume 14, Issue 1, DOI: 10.1186/1129-2377-14-5