Abstract
ObjectiveThis quality improvement project was implemented in order to highlight the association between headache, mTBI and depression on lost productivity and resource utilization.BackgroundMood disorders, environment and traumatic brain injury are common in patients with headache, and have been shown to influence clinical course, treatment response and outcome. Although widely recognized, the association of these factors on clinical outcomes, resource utilization and productivity is not well understood.MethodsAll patients presenting to a military referral center for migraines are assessed for presence of traumatic brain injury, Headache Impact Score (HIT-6) and Patient Depression Questionnaire (PHQ-9). Based on screening, patients are offered referral to mental health and a multidisciplinary headache education course.Results237 patients were seen for headache or migraine. 180 patients had severely disabling headaches. These patients accounted for 146 emergency room visits over the course of one year. Of headache patients, 65% met criteria for depression and 15% of patients had severe depression. Only 37% of these patients carried a formal diagnosis of depression and 38% had been seen by mental health. Lost productivity and duty limitations were significantly associated with severity of depression. In service members screening positively for mild, moderate or severe depression, duty restrictions had been placed on 8.3%, 32.5% and 53.8%, respectively. Only 3.8% of patients who did not screen for depression had similar duty limitations. A history of mTBI strongly correlated with comorbid depression. Lost productivity and duty limitations were not impacted by other headache characteristics or HIT-6 scores.ConclusionsThis quality improvement project identified a practice gap for treatment of comorbid depression in patients presenting to Neurology for headache. Depression strongly correlated with productivity loss, highlighting a possible target for the economic burden of headache.
Highlights
Mood disorders, environment and traumatic brain injury are common in patients with headache, and have been shown to influence clinical course, treatment response and outcome
All patients presenting to a military referral center for migraines are assessed for presence of traumatic brain injury, Headache Impact Score (HIT-6) and Patient Depression Questionnaire (PHQ-9)
This quality improvement project identified a practice gap for treatment of comorbid depression in patients presenting to Neurology for headache
Summary
Environment and traumatic brain injury are common in patients with headache, and have been shown to influence clinical course, treatment response and outcome. In 2010, headache accounted for greater than 3% of all emergency room visits, and was documented as the fourth leading cause of visits to the emergency department within the United States [1]. This has considerable financial implications, through utilization of healthcare resources and lost productivity in the workplace [3, 4]. Headache accounts for greater than 50% of outpatient Neurology encounters It is a cause for medical attention in 4% of all service members, placing significant demands on the healthcare system [8]
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