The quality of diagnosis and management of migraine and tension-type headache in three social groups in Russia.

Background Three successive editions of the International Classification of Headache Disorders and multiple guideline papers on headache care have described evidence based diagnosis and treatment of headache disorders. It remains unknown, however, to which extent this has improved the diagnosis and management of headache. That was the aim of our study in which we also analysed differences between three social groups in Russia. Methods We studied 1042 students (719 females, 323 males, mean age 20.6, age range 17-40), 1075 workers (146 females, 929 males, mean age 40.4, age range 21-67) and 1007 blood donors (484 females, 523 males, mean age 34.1, age range 18-64). We conducted a semi-structured, validated, face-to-face professional interview. Data on prevalence and associated factors have previously been published. A section of the interview focused on previous diagnosis and treatment, the topic of this paper. Results Only 496 of 2110 participants (23%) with headache in Russia had consulted because of headache. Students consulted more frequently (35%), workers and blood donors less often (13% and 14%). Only 12% of the patients with ICHD-3beta diagnosis of migraine and 11.7% with ICHD-3beta diagnosis of tension-type headache (TTH) had previously been correctly diagnosed. Triptans were used by only 6% of migraine patients. Only 0.4% of migraine patients and no TTH patients had received prophylactic treatment. Conclusion Despite existing guidelines about diagnosis and treatment, both remain poor in Russia. According to the literature this is only slightly better in Europe and America. Dissemination of existing knowledge should have higher priority in the future.

Psychosocial factors associated with migraine and tension-type headache in medical students.

Background In our previous study of workers, blood donors and medical students, students stood out with a higher 1-year prevalence of migraine (28%) and tension-type headache (TTH) (74%). General factors associated with headache were common for all groups except low physical activity. The hypothesis of this study was therefore that a number of psychosocial factors relating to the personal sphere would better explain the high prevalence of migraine and TTH in students. Methods The study population consisted of 1042 students (719 females, 323 males, mean age 20.6, range 17-40). Headache diagnoses and associated factors were identified by direct professional semi-structured interview. We also interviewed about the following psychosocial factors: dissatisfaction with study, dissatisfaction with family life, dissatisfaction for personal reasons, bad financial situation, overwork, stress, not enough sleep, insomnia, depressed mood, anxiety, irritability, tendency towards conflicts and not being married. We report psychosocial factors associated with headache according to diagnosis and sex using univariate and multivariate logistic regression analyses. Results Several factors were significantly associated with migraine and TTH in the univariate analysis. In the multivariate analysis, two psychosocial factors were statistically significantly associated with migraine in all students: irritability (OR 2.2, 95% CI 1.4-3.6) and overwork (OR 2.2, 95% CI 1.4-3.5). Insomnia (2.7, 95% CI 1.1-6.9) and depressed mood (OR 2.1, 95% CI 1.1-4.2) were associated with migraine only in females. Two psychosocial factors were associated with TTH: dissatisfaction with study in males (OR 2.0, 95% CI 1.0-3.8) and depressed mood in females (OR 1.8, 95% CI 1.0-3.5). Conclusion Psychosocial factors from the personal sphere showed significant association with migraine and TTH in students. Such factors should therefore be major targets for preventive efforts to reduce the prevalence of primary headache disorders in students.

Factors Associated with Primary Headache According to Diagnosis, Sex, and Social Group.

BACKGROUND: We previously showed that migraine and tension-type headache (TTH) have a high prevalence that differs markedly between social groups. Here, we aim to identify factors associated with migraine and TTH (possible risk factors) in three social groups to better understand the difference in prevalence between sexes, between different headache diagnoses, and between different social groups. MATERIAL AND METHODS: The study included 3124 persons: 1007 blood donors (484 females, mean age 34.1), 1075 workers in an oil and gas factory (146 females, mean age 40.4), and 1042 medical students (719 females, mean age 20.6). Headache diagnoses and associated factors were identified by direct or telephone interview using a semistructured, validated form. It was administered by a neurologist or by specially trained senior medical students under supervision of a neurologist. RESULTS: We report factors associated with headache according to diagnosis, sex, and social group using multivariate logistic regression analysis. (1) According to diagnosis. Many associated factors were common for migraine and TTH: female sex, arterial hypertension, history of head trauma, and consumption of light alcoholic beverages. To be a student was associated with the highest risk of migraine (OR 6.6; 95% CI 4.2-10.4) and TTH (OR 3.6; 95% СI 2.7-4.8). Low physical activity (OR 1.6; 95% CI 1.0-2.4) and family history of headache (OR 2.1; 95% CI 1.5-2.9) were associated only with migraine. Current smoking and BMI > 25 were negatively associated with migraine and TTH. (2) According to sex. Common factors associated with migraine and TTH in both sexes included history of head trauma, family history of headache, and arterial hypertension. Use of alcohol was different between sexes: in males consumption of strong alcoholic beverages was associated with TTH (OR 1.5; 95% CI 1.0-2.0) and in females consumption of light alcoholic beverages was associated with migraine (OR 3.49; 2.03-6.02) and TTH (OR 3.0; 95% CI 1.93-4.66). Low physical activity was associated with migraine in females (OR 1.9; 95% CI 1.1-3.2). (3) According to social group. Common factors associated with headache in all groups included female sex, family history of headache, history of head trauma, and arterial hypertension. Consumption of light alcoholic beverages was associated with migraine and TTH in blood donors and students. Only two factors were specific to a social group: consumption of strong alcoholic beverages was associated with TTH in blood donors (OR 1.5; 95% CI 1.1-2.1), low physical activity was associated with migraine in students (OR 1.98; 95% CI 1.04-3.74) and with TTH in workers (OR 2.1; 95% CI 1.2-3.7). CONCLUSION: Most of the associated factors were shared by the sexes. The associated factors varied somewhat more between migraine and TTH and between social groups. To be a student was associated with the highest risk of headache. Factors different from those in the present and previous studies should be studied in the future in order to better understand the differences in associated factors according to diagnosis, sex, and social group.

Prevalence of primary headache disorders diagnosed according to ICHD-3 beta in three different social groups.

BACKGROUND: The aim of our study was to estimate the one-year prevalence of primary headache disorders in three different social groups using the third edition beta of the International Classification of Headache Disorders (ICHD-3 beta). MATERIAL AND METHODS: The study population included a total of 3124 participants: 1042 students (719 females, 323 males, mean age 20.6, age range 17-40), 1075 workers (146 females, 929 males, mean age 40.4, age range 21-67) and 1007 blood donors (484 females, 523 males, mean age 34.1, age range 18-64). We used a semi-structured, validated face-to-face interview. RESULTS: The age-adjusted one-year prevalence of migraine in females was significantly higher (p < 0.001) in students (41.9%) than in workers (19.2%) and blood donors (18.7%). Age-adjusted prevalence of migraine among males did not differ among the three groups: 4.5% in students, 4.9% in workers and 4.5% in blood donors. Age-adjusted prevalence of tension-type headache (TTH) among females was almost the same in students and blood donors (68.8% and 66.7%) but female workers had a lower prevalence of TTH (57%). Age-adjusted prevalence of TTH among males did not differ significantly between students and blood donors (55.8% and 58.1%) but male workers had a significantly lower (p < 0.001) prevalence of TTH (30.7%). The prevalence of chronic headache in students (TTH and/or migraine) was 3% and of probable medication-overuse headache 3%, significantly more than in workers and blood donors. CONCLUSION: Headache prevalence was high and differed markedly among the three social groups. It is important that headache epidemiology also focus on socially defined groups in order to target future preventive efforts.