Nosology and treatment of primary headache in a Swiss headache clinic

Abstract

We assessed demographics, diagnoses, course, severity, impact and treatment of primary headache outpatients from records in the Headache and Pain Clinic, Neurological Department, Zürich University Hospital. All outpatients seen from 1996 to 1998 for migraine, tension–type headache, and both, were included. Diagnoses, drug, physical and alternative treatments before and after referral were listed. Descriptive statistics were used for differences between the general population and this sample, the diagnoses, and treatments. The coexistence of migraine and tension–type headache, and the high frequencies of headache days would have excluded most migraine patients from typical drug trials: at best, only one third were eligible. The socioeconomic impact of combined and difficult syndromes calls for comprehensive management beyond simple treatment with instant relief drugs. The diagnostic and therapeutic practices of referring physicians exposed a deficit of information on headache, and a need for relevant education.

Development and validation of the Asian Migraine Criteria (AMC)

“…We used the AMC in a headache clinic that has a higher rate and severity of migraine headache compared to primary care centers. 12 The number of patients in our study who contributed to groups other than true-positive was small, and this has probably affected the NPV and PPV, which are critically dependent on the prevalence of the disorder in the sample. Because of these limitations, the validity of the NPV and PPV should be confined to the patient population of tertiary headache centers.…”

“…13 The ICHD-I had a sensitivity of 27.3% and a specificity of 92.4% for migraine diagnosis, 13 and these poor results for childhood migraine result from the rarity of certain migraine features in children. 12 Senbil et al compared the ICHD-II, as the gold standard, with the clinical diagnoses of a pediatric neurologist, and found that the ICHD-II had 90.3% specificity, 78.7% sensitivity and a high validity for the diagnosis of migraine. 14 In another study of children and adolescents, the ICHD-II had a sensitivity of 53% and 71% for migraine without, and with, aura compared to the clinical diagnosis of experts as gold standard.…”

Complementary and Alternative Medicine Use Among Adults With Migraines/Severe Headaches

“…However, little is known about the patterns of CAM use in adults with migraines. Only a few prior surveys have examined CAM use in patients with headaches, and most were conducted in outpatient headache centers with small samples 5,9‐14 . Knowing the prevalence and patterns of use of CAM in adults with migraines will help to characterize areas of potential underuse and barriers to use, as well as potential risks of CAM therapies in adults with migraines.…”

Awareness of headache and of national headache society activities among primary care physicians – a qualitative study

“…Nonetheless, in a study conducted in the United Kingdom, Kernick et al reported that 70% of patients presenting to GPs with new-onset primary headaches did not receive a diagnosis [3], which might be due to the fact that primary healthcare often deals with early undifferentiated stages of illnesses. An earlier study in a Swiss tertiary care centre revealed a similarly high number of incorrect or unspecified diagnoses [9]. The clinical problem of headache demands appropriate medical attention, and it seems that the cooperation between primary care physicians and headache specialists still needs to be improved.…”