Headache Patients in Primary Care and a Tertiary Care Unit in Zürich, Switzerland

Abstract

The Headache and Pain Clinic (HPC) is a unit of the Zürich Neurology Department, established in 1966. In the present study demographic features, clinical characteristics and medical management of primary and tertiary care patients were compared in two groups of 181 patients each, seen by general practitioners (GPs) or the HPC, respectively, for primary headaches in 1998. There was a preponderance of women and the socially underprivileged in both samples. Chronic headache was overrepresented in the HPC (44.7%). Loss of work for >2 months was found exclusively in the HPC (9.9%). Of the GP patients, 40% were using triptans and 26.5% in the HPC. One-third of both groups had had complementary and alternative medical treatment. Differences in management strategies reflected differences in headache severity and chronicity. Results indicated that remaining shortcomings of diagnosis and treatment of headache in primary care could be minimized by involving GPs in similar non-commercial studies.

Treatment of migraine and tension-type headache in Croatia

“…Approximately 40% of patients with M and PM were satisfied with alternative methods, whereas in the TTH group this percentage was even higher, at 60%. Studies from other countries show that patients relatively frequently reach for alternative methods for headache treatment: approximately one-third of patients in Italy, Switzerland, and Singapore tried at least one method [25, 36, 37]. Analysis of patients who visited a specialized headache clinic revealed that even 84% tried one or more alternative methods and 60% of those stated that these methods were efficient [38].…”

Relative frequency of headache types: a longitudinal study in the tertiary care

“…In studies from Europe, prevalence of CDH ranged from 27% to 60% at the tertiary care [5][6][7] . The diagnosis frequency had changed significantly among the CDH between the two assessments, although the absolute number remain relatively stable -n=45 in 2007 and n=41 in 2007.…”

“…Around 87% of the patients had some form of migraine both in the first and second assessments. Other studies conducted at the tertiary care found that the prevalence of migraine at this setting ranges from 33 to 80% [3][4][5][6]8 . A past study conducted in our clinic diagnosed migraine in 79.2% of the patients 3 .…”

“…Indeed, CDHs describe primary or secondary headache happening on 15 or more days per month, for at least 3 months, lasting at least 4 hours per day 10 . Most studies conducted in the tertiary care are retrospective or cross-sectional [3][4][5][6][7] . Few studies followed the patients longitudinally, using the ICDH-II to diagnose the headaches.…”

“…In this setting, tension-type headache (TTH) is the most common headache type, followed by migraine 1,2 . In the tertiary care, however, migraine and chronic daily headaches (CDH), are far more common than TTH [3][4][5][6][7][8] . CDHs do not represent a distinct nosologic entity, as per the second edition of the International Classification of Headache Disorders (ICDH-II) 9 .…”