Characteristics of Patients Referred To A Specialized Headache Clinic

Abstract

Headache is a common problem with great effect both on the individual and on the society. Recent studies raised the possibility of increasing rate of specialty referrals, inappropiate treatment and advanced imaging for simple headache. The aim of our study was to analyze the characteritics of patients (including duration of symptoms, headache type, brain imaging, treatment) referred to our specialized headache clinic between 01/01/2014 and 01/01/2015 by their general practitioners and primary care neurologists due to chronic/treatment-resistant headache syndromes. 202 patients (mean age 53.6 ± 17.6 years) were evaluated in our clinic (102 females, mean age 50.14 ± 16.11 years and 100 males, mean age 57 ± 18.1 years). Migraine (84/202) and tension-type (76/202) were the most common syndromes. 202 plain brain CT, 60 contrast-enhanced CT and 128 MRI were carried out by their general practitioners or other healthcare professioners including neurologists before referral to our headache centre. Despite of extensive brain imaging appropiate treatment was started less than 1/3 of all patients and significant proportion received benzodiazepines or opioid therapy. Furthermore, more than 10% of referred patients presented with secondary headache including one meningitis. The management of headache is still a challenge for primary care physicians leading to medical overuse. Vast majority of our patients should not be referred to our specialized headache clinic as they had uncomplicated headache or other underlying conditions than pain.

Utilization of a neurology specialty service by primary care providers for headache management at a tertiary care hospital

“…Headaches were triaged according to the perceived level of urgency. Relevant factors that prompted an accelerated assessment included 1 : Sudden onset of headache 2 ; new onset of headache 3 ; increased frequency or severity of headache 4 ; onset of headache after 50 years of age 5 ; headache with concomitant systemic illness 6 ; headache associated with focal neurologic signs or symptoms 7 ; headaches associated with papilledema 8 ; prior status migrainosus diagnosed by a neurologist 9 ; treatment-refractory cluster headaches 10 ; consult requests by a community neurologist.…”

“…This includes emergency room visits, 7 , 8 as well as consult requests to primary care providers 9 and specialty clinics. 10 While some headache disorders are considered neurological emergencies that should be assessed in an emergency department or by a neurologist, 11 many headache disorders are chronic, mild-to-moderate in severity, and can be managed in a primary care setting. 12 , 13 In fact, given the numerous co-morbidities associated with many headache disorders, participation of primary care providers in the care of these patients appears intuitive.…”

Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi‐center study

“…Assuming a migraine prevalence of 35% in headache clinics [45][46][47] and a sample sensitivity of 80% for CDE, the sample size needed for a two-sided 85% sensitivity confidence interval (CI) with a width of at most 0.15, is 203. 48,49 Assuming a migraine prevalence of 35% in headache clinics [45][46][47] and a sample specificity of 80% for CDE, the sample size needed for a two-sided 85% specificity CI with a width of at most 0.15, is 110. 48,49 The whole table sample size required so that both CIs have widths less than 0.15, is 203, the larger of the two sample sizes.…”

Managing migraine on the frontline: Identifying disease, understanding burden, and incorporating CGRP pathway-targeting therapies in primary care

“…18 Untreated or sub-optimally managed migraine can also lead to unnecessary health care costs including avoidable specialist referrals, advanced imaging, and ER visits. 19,20…”

“…18 Untreated or sub-optimally managed migraine can also lead to unnecessary health care costs including avoidable specialist referrals, advanced imaging, and ER visits. 19,20 Adding to the burden of migraine is its association with many comorbid conditions, including cardiovascular disease, psychiatric disorders, and sleep conditions. 21 Higher headache frequency and more severe headache pain are associated with increased risk for many of these comorbidities.…”