ABSTRACT
RESUMEN INTRODUCCIÓN: La migraña y la cefalea tipo tensional son los dolores de cabeza primarios más frecuentes en la consulta médica; la mejoría clínica de los pacientes se relaciona con la educación brindada y la prescripción de tratamientos profilácticos por parte de sus médicos tratantes. OBJETIVO: Determinar la frecuencia de prescripción del tratamiento profiláctico y de la realización de explicaciones educativas al paciente con cefalea primaria por parte de los médicos de atención primaria, además de los factores asociados a ellas. MATERIALES Y MÉTODOS: Estudio de corte transversal con 152 pacientes con criterios para migraña o cefalea tensional de la ICHD y con indicación para tratamiento profiláctico según las guías canadienses, que fueron atendidos por médicos de atención primaria. Se aplicó un cuestionario para establecer el tipo de prácticas realizadas por los profesionales y se realizó un análisis univariado y bivariado. RESULTADOS: Solo al 23 % de los pacientes le formularon tratamiento profiláctico, el 56 % nunca recibió explicación educativa sobre su enfermedad y el 70 °% nunca había sido remitido a consulta de neurología. El 44 °% respondió no saber sobre el origen de la cefalea y se encontró una asociación significativa entre el nivel educativo del paciente y el hecho que le ofrecieran explicación educativa. CONCLUSION: La frecuencia en la formulación de profilaxis farmacológica y realización de explicaciones educativas al paciente por parte del médico de atención primaria fue baja. Esto puede relacionarse con un desconocimiento de los protocolos de manejo en cefalea primaria y fallas en las habilidades clínicas recibidas en el pregrado.
SUMMARY INTRODUCTION: Migraine and tension type headache are the most frequent primary headaches in the medical practice; the clinical improvement of the patients is related to the education carry out by his physician and the prescription of prophylactic treatments. Migraine and tension-type headache are the most frequent primary headaches in the medical office; the clinical improvement of the patients is related to the education provided and the prescription of prophylactic treatments by their treating doctors. OBJECTIVE: To determine the frequency of prescription of prophylactic treatment and of educational explanations to the patient with primary headache by primary care physicians, and the possible factors associated with them. MATERIALS AND METHODS: Cross-sectional study with 152 patients that have Migraine or Tensional Headache according to the ICHD criteria and that had an indication for prophylactic treatment according to the Canadian guidelines for the prophylaxis management of patients with migraine, which were attended by primary care physicians. Application of a questionnaire to establish the type of practices carried out by professionals; an univariate and bivariate analysis was performed. RESULTS: 56 °% of the patients never received an educational explanation about their disease, 70 °% had never been referred to a neurology consultation previously, and 23 % had been prescribed prophylactic treatment. 44 °% answered not knowing about the origin of the headache and found a significant association between the educational level of the patient and the fact that they offered educational explanation. CONCLUSION: The frequency of formulation of pharmacological prophylaxis and the performance of educational explanations to the patient by the Primary Care Physician was very low; This may be related to a lack of knowledge of management protocols in primary headache and to flaws in the clinical skills previously obtained in undergraduate training.
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Transit-Oriented DevelopmentABSTRACT
Objective: A hospital based observational study of Primary headache disorders among pregnant women attending tertiary care hospitals in Srinagar. Methods: The study sample comprised of pregnant women who reported to ante-natal clinics or medical outpatients department of associated hospitals of Govt. medical College, Srinagar, with the chief complaint of headache. A pretested questionnaire was presented to the participants and the diagnosis of various primary headache disorders was established by adopting the ICHD-2 criteria. Results: Among 2000 women screened, 34.25% of cases complained of headaches during pregnancy. Primary headache disorders (migraine, tension-type headache) was observed in 70.51% patients. Conclusion: Among primary headache disorders, migraine and tension type headache were observed in (59.48%) and (39.65%) cases respectively.
ABSTRACT
BACKGROUND AND PURPOSE: New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups. METHODS: We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version. RESULTS: In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040). CONCLUSIONS: Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.
Subject(s)
Aged , Female , Humans , Age of Onset , Classification , Diagnosis , Electrooculography , Headache Disorders , Headache Disorders, Primary , Headache Disorders, Secondary , Headache , Korea , Migraine Disorders , Prescription Drug Overuse , Prospective Studies , Tension-Type Headache , Tertiary Care CentersABSTRACT
PURPOSE: Childhood headache is different from adulthood headache and according to their age in clinical aspects. This study investigated the clinical differences of primary headache according to ages of children and adolescents. METHODS: A 300 children who did not show abnormalities on neurologic examination or brain CT or MRI were classified into two groups according to their ages. RESULTS: The percentage of those in the migraine group (24.2% vs. 35.9% in Groups 1 and 2 respectively) was higher in Group 2, but it was not statistically significant. In relation to the duration of headache, pain lasting for less than one hour accounted for 59.8% and 40% in Groups 1 and 2, respectively (P=0.001). In relation to the location headaches developed, the frontal region (40.2%) and temporal region (48.1%) were the most common in Groups 1 and 2, respectively (P<0.001). In relation to the nature of the headaches, tightening sensation accounted for the highest percentage in both groups; however, pulsating sensation were more common in Group 2 than in Group 1 (16.2% vs. 8.3%, P=0.038). In relation to the severity of headaches, severe to profound headaches accounted for 35.5% and 61.1% in Groups 1 and 2, respectively (P<0.001). In relation to laterality, unilateral headaches accounted for 12.4% and 26.7% in Groups 1 and 2, respectively (P=0.002). In relation to accompanying symptoms, the incidence of photophobia was higher in Group 2 than in Group 1 (P=0.047). CONCLUSION: Age factors should be considered in the diagnosis of childhood headaches. Also, we consider that there may be a need to establish diagnostic criteria specifically for childhood headaches separately from those for adulthood headaches.