Treatment Realities of Headache Disorders in Rural Germany by the Example of the Region of Western Pomerania

Thiele, Anne; Strauß, Sebastian; Angermaier, Anselm; Klehr, Lara; Bartsch, Luise; Kronenbuerger, Martin; Fleischmann, Robert

doi:10.3390/brainsci11070839

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…Thus, perception of the medial representation of migraine may differ based on the urbanity of the place of residence. Access to specialty care may also be more limited in rural areas, leading to more patients being treated by general practitioners [33] and resulting in differences in their care when compared to urban areas. For example, studies have shown that especially chronic migraine patients treated by general practitioners often do not get referred to a specialist and tend to receive acute and preventive medication not in accordance with local and international guidelines [34,35].…”

Section: Introductionmentioning

confidence: 99%

Perception of typical migraine images on the internet: Comparison between a metropolis and a smaller rural city in Germany

Hamann,

Hong,

Lange

et al. 2023

PLoS ONE

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The medial portrayal of migraine is often stereotypical and inaccurate but reflects how society perceives migraine. The discrepancy between others’ views and the reality of affected individuals may negatively affect access to treatment and the disease course of patients with migraine. This study aimed to investigate whether images presented in the media as typical migraine attacks are perceived as realistic and representative by migraine patients in Rostock, a smaller town in rural Germany, and compare the results to those from Berlin, a large metropolis. We performed an online survey in Rostock. Migraine patients were shown ten images of migraine attacks, which were among the most downloaded stock pictures on the internet under the search term "migraine". They rated on a scale of 0–100 to what extent the pictures were realistic for migraine attacks (realism score), representative of their own migraine (representation score), or the society’s view of migraine (society score). In addition, we compared our results with a recently published study from the metropolitan region of Berlin. A total of 174 migraine patients completed our survey. Mean (SD) realism, representation, and society scores were 59.9 (17.5), 56.7 (18.3), and 58.4 (17.1) respectively. Images of older patients were perceived as significantly more realistic and representative than those of younger patients (P < .001). Patients in Rostock (rural region) rated the images as significantly more realistic and representative than survey participants in Berlin (metropolis). Migraine patients in a rural region found typical migraine images only moderately realistic and representative but to a higher degree than their counterparts from a metropolis.

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Section: Introductionmentioning

confidence: 99%

Perception of typical migraine images on the internet: Comparison between a metropolis and a smaller rural city in Germany

Hamann,

Hong,

Lange

et al. 2023

PLoS ONE

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“…However, making the correct diagnosis can be challenging for physicians not specialized in headache care as there are more than 200 distinct headache disorders defined by the international classification of headache disorders (ICHD-3) (1). Moreover, especially in rural areas, headache care must be maintained primarily by nonheadache specialists (primarily primary care physicians) who are often not adequately trained (2,3). Therefore, questionnaires have been developed to screen for main primary headache disorders such as migraine (MIG), tension-type headache (TTH), or trigeminal autonomic cephalalgias (TACs) for both clinical routine and research.…”

Section: Introductionmentioning

confidence: 99%

Reliability of a telephone interview for the classification of headache disorders

Angermaier,

Koennecke,

Kloetzer

et al. 2023

Front. Neurol.

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ObjectiveThe study aimed to test the reliability of a semi-structured telephone interview for the classification of headache disorders according to the ICHD-3.BackgroundQuestionnaire-based screening tools are often optimized for single primary headache diagnoses [e.g., migraine (MIG) and tension headache (TTH)] and therefore insufficiently represent the diagnostic precision of the ICHD-3, which limits epidemiological research of rare headache disorders. Brief semi-structured telephone interviews could be an effective alternative to improve classification.MethodsA patient population representative of different primary and secondary headache disorders (n = 60) was recruited from the outpatient clinic (HSA) of a tertiary care headache center. These patients completed an established population-based questionnaire for the classification of MIG, TTH, or trigeminal autonomic cephalalgia (TAC). In addition, they received a semi-structured telephone interview call from three blinded headache specialists individually. The agreement of diagnoses made either using the questionnaires or interviews with the HSA diagnoses was evaluated.ResultsOf the 59 patients (n = 1 dropout), 24% had a second-order and 5% had a third-order headache disorder. The main diagnoses were as follows: frequent primary headaches with 61% MIG, 10% TAC, 9% TTH, and 5% rare primary and 16% secondary headaches. Second-order diagnosis was chronic migraine throughout, and third-order diagnoses were medication overuse headache and TTH. Agreement between main headaches from the HSA was significantly better for the telephone interview than for the questionnaire (questionnaire: κ = 0.330; interview: κ = 0.822; p < 0.001). Second-order diagnoses were not adequately captured by questionnaires, while there was a trend for good agreement with the telephone interview (κ = 0.433; p = 0.074). Headache frequency and psychiatric comorbidities were independent predictors of HSA and telephone interview agreement. Male sex, headache frequency, severity, and depressive disorders were independently predictive for agreement between the questionnaire and HSA. The telephone interview showed high sensitivity (≥71%) and specificity (≥92%) for all primary headache disorders, whereas the questionnaire was below 50% in either sensitivity or specificity.ConclusionThe semi-structured telephone interview appears to be a more reliable tool for accurate diagnosis of headache disorders than self-report questionnaires. This offers the potential to improve epidemiological headache research and care even in underserved areas.

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Effect of video consultation for non-acute headache by neurologist on consultation rate in general practice during one-year follow-up. Randomized controlled trial

Bekkelund

2023

Preprint

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Background Patient´s access to headache specialists varies in the population. Video consultations may help, but the effect of using communication technology on headache management in the population is incompletely understood. This study determined whether use of video consultations for non-acute headache patients at specialist were noninferior to face-to-face consultations in the need for subsequent headache visits in general practice at follow-up. Methods Four hundred and two non-acute headache patients consecutively referred to neurologist from general practitioners in North Norway were included in a randomized controlled noninferiority trial. Frequency of patients consulting general practitioner for headache and median number of headache consultations 0–12 months after specialist consultation were compared between groups initially consulted by video or face-to-face consultations. Results Ninety-two (60.9%) of the patients in the video group and 93 (66.4%) in the face-to-face group consulted general practitioners for headache problems during the follow-up period, p = 0.274. The median (IQR range) number of consultations were 1 (IQR: 0–14) (video) and 1 (IQR: 0–15) (face-to-face), p = 0.154. Clinical characteristics including, headache impact, pain score and patients satisfied with headache information, communication, headache advice, diagnostic information, and headache medication at GP during follow-up were similar between the two groups. Conclusion Treating headache patients by using video consultations at neurologist did not result in higher consultation rate at follow-up in general practice. These data support use of video as a useful method in the treatment of headache at specialist in terms of organization of headache management in the population. Trial registration: Trial registration number NCT02270177. Registration date: October 2, 2014

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Treatment Realities of Headache Disorders in Rural Germany by the Example of the Region of Western Pomerania

Cited by 3 publications

References 22 publications

Perception of typical migraine images on the internet: Comparison between a metropolis and a smaller rural city in Germany

Perception of typical migraine images on the internet: Comparison between a metropolis and a smaller rural city in Germany

Reliability of a telephone interview for the classification of headache disorders

Effect of video consultation for non-acute headache by neurologist on consultation rate in general practice during one-year follow-up. Randomized controlled trial

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