Characteristics of Patients Referred to a Specialized Headache Clinic

DOI: https://doi.org/10.1038/s41598- 020- 58234- w

Abstract-Summary Recent studies raised the possibility of increasing rate of specialty referrals, inap- propiate 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 head- ache 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. More than 10% of referred patients presented with secondary headache includ-

ing one meningitis.

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. Extended: Vast majority of our patients fulfilled the criteria of chronic headache syndromes (those with migraine and tension-type headache) and were not properly managed in the primary care.

Vast majority of our primary headache patients fulfilled the criteria of chronic headache, but less than one-third of them received proper prohylactic or mainte- nance therapy in accordance with the current European and Hungarian recommendations.

Introduction As headache disorders are amongst the leading cause of years lived with disability worldwide (migraine alone is ranked as third among people aged 15 to 49 years) to improve the management of patients with headache, the Hungarian Headache Society established 29 Specialized Headache Centers, which accept referrals from general practitioners (and other medical professioners) or from neurologists not specialized in headache [46, 513].

Our specialized headache center was established in 2014 in Szigetvar, accepting referrals from 3 primary hospitals, 4 general outpatient clinics and 25 general prac- titioners, overall covering more than 70,000 patients in South West Hungary [513]. As only several reports (and no studies from our country) are available with regard to primary care management of headache patients we overtook a retrospetive study to analyze the characteritics of patients (including duration of symptoms, headache type, brain imaging, treatment and cardiovascular risk factors) referred to

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our headache clinic by their general practitioners and primary care neurologists due to chronic/treatment-resistant headache syndromes.

Patients and Methods 202 patients were referred to our outpatient service between 01/01/2014 and 01/01/2015 and data were retrospectively analyzed.

Duration of symptoms, brain imaging (including plain computer tomograph / CT/, contrast-enhanced CT and magnetic resonance imaging /MRI/), previous out- patient/hospital attendance due to headache and treatment strategies were extracted from hospital notes.

Cardiovascular risk profile factors and previous diseases of relevance to this study included, smoking habit, diabetes mellitus, hypertension, dyslipidaemia, isch- aemic heart disease (IHD), history of stroke and peripheral artery disease.

Informed consent were not given to the patients due to the retrospective nature of

the study.

Results Migraine was diagnosed in 84 patients (mean age 46.1 ± 14.7 years) corresponding to the IHS criteria (66 females, mean age 47.12 ± 15.3 years and 18 males, mean age 42.22 ± 11.3 years).

Tension-type headache was diagnosed in 76 patients (mean age 59.66 ± 17.9 years) corresponding to the IHS criteria (22 females, mean age 61.8 ± 17.3 years and 54 males, mean age 54.18 ± 18.4 years, p < 0.05).

Trigeminal-autonomic cephalagia was diagnosed in 18 patients (mean age 45.33  ±  12.3  years) corresponding to the IHS criteria (8 females, mean age 57.7 ± 5.1 years and 10 males, mean age 35.4 ± 5.1 years, p < 0.05), including 15 cluster headaches, 1 short-lasting unilateral neuralgiform headache with conjuncti- val injection and tearing (SUNCT) syndrome and 2 hemicrania continua head- ache [514].

Discussion About 20% of headache patients were properly managed in primary care which resulted in unnecessary emergency admissions and enourmous number of brain imaging.

Despite all guidelines recommend against opioids as first-line treatment for acute migraine and other primary headaches, they were prescribed for about 20% of our patients (with the highest rate in secondary headaches).

Vast majority of our patients fulfilled the criteria of chronic headache syndromes (those with migraine and tension-type headache) and were not properly managed in the primary care.

This is in concodance with recent studies, the diagnosis and management of migraine (and other primary headache syndromes - especially chronic forms) are still a challenge for primary care physicians [515].

Due to inappropiate primary care management, our patients had several emer- gency admissions, which were the most common in patients with trigeminal- automic cephalagia, females with migraine and males with tension-type headache.

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Acknowledgement A machine generated summary based on the work of Fejes, Eva; Feher, Gergely; Gurdan, Zsuzsanna; Gombos, Katalin; Koltai, Katalin; Pusch, Gabriella; Tibold, Antal. 2020 in Scientific Reports.

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