Abstract
This study aimed to analyze and classify the clinical features of headache in neurological outpatients. A cross-sectional study was conducted consecutively from March to May 2010 for headache among general neurological outpatients attending the First Affiliated Hospital of Chongqing Medical University. Personal interviews were carried out and a questionnaire was used to collect medical records. Diagnosis of headache was according to the International classification of headache disorders, 2nd edition (ICHD-II). Headache patients accounted for 19.5% of the general neurology clinic outpatients. A total of 843 (50.1%) patients were defined as having primary headache, 454 (27%) secondary headache, and 386 (23%) headache not otherwise specified (headache NOS). For primary headache, 401 (23.8%) had migraine, 399 (23.7%) tension-type headache (TTH), 8 (0.5%) cluster headache and 35 (2.1%) other headache types. Overall, migraine patients suffered (1) more severe headache intensity, (2) longer than 6 years of headache history and (3) more common analgesic medications use than TTH ones (p < 0.001).TTH patients had more frequent episodes of headaches than migraine patients, and typically headache frequency exceeded 15 days/month (p < 0.001); 22.8% of primary headache patients were defined as chronic daily headache. Almost 20% of outpatient visits to the general neurology department were of headache patients, predominantly primary headache of migraine and TTH. In outpatient headaches, more attention should be given to headache intensity and duration of headache history for migraine patients, while more attention to headache frequency should be given for the TTH ones.
Highlights
Headache is experienced by the majority of the population and has a major impact on public health
A total of 1,683 cases of headache patients were investigated; 640 (38%) patients were seeking medical advice regarding their headache for the first time, 960 (57.1%) patients had consulted for their headache previously and 83 (4.9%) patients were unable to recall their headache consultation history
Primary headache patients accounted for 50.1% of all headache patients in our study, and migraine and tensiontype headache (TTH) accounted for 23.8% (401/1,683) and 23.7% (399/1,683) of the total, respectively
Summary
Headache is experienced by the majority of the population and has a major impact on public health. The prevalence of active headache disorder is 47%, migraine 10%, tension-type headache (TTH) 38% and chronic headache 3%; the disability attributable to TTH is larger worldwide than that due to migraine [1]. Patients who consult doctors have different clinical features and the distribution of headache types seen in the clinic differs from population-based studies. In a clinical study from a headache center in east Hungary [4], migraine was the most common headache, while TTH patients reported more severe disability than migraines. A study from Denmark [7] reported that 56% of migraine patients and 16% of patients with TTH were seen by their family practitioner, whereas 16% of migraine and 4% of TTH patients sought specialist consultation
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