TY - JOUR
T1 - Diagnostics and management of headache in general practice
AU - Carlsen, Louise Ninett
AU - Stefansen, Simon
AU - Ahnfeldt-Mollerup, Peder
AU - Højland Jensen, Rigmor
AU - Saxhaug Kristoffersen, Espen
AU - Møller Hansen, Jakob
AU - Lykkegaard, Jesper
N1 - © The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2024/8/14
Y1 - 2024/8/14
N2 - BACKGROUND: Headache disorders are globally prevalent and insufficient treatment contribute to low quality of life, increased disability, and socioeconomic costs. However, headache can to a large extent be treated appropriately by general practitioners.OBJECTIVE: To explore general practitioners' (GPs') management of patients with headache lasting ≥6 months.METHODS: In this retrospective descriptive cross-sectional study based on medical audit, all GPs practicing in Vejle municipality (population 116,992), Denmark, were invited to review their latest 20 patients with headache. Outcome measures were headache diagnostics, treatment, and referrals. Factors associated with referral to neurological treatment were examined by logistic regression.RESULTS: Of 26 invited practices, 19 participated reporting on 367 patients with lasting headache (71.4% women; mean-age 48.5 years). One hundred and sixty-one patients had migraine (44%; IQR: 28-60%), 140 (38%; IQR: 25-44%) had tension-type headache; 243 (66%; IQR: 50-79%) used simple analgesics, 147 (40%; IQR: 29-59%) triptans, 37 (10%; IQR: 0-14%) opioids, 93 (25%; IQR: 20-35%) were prescribed preventive medication; 176 (48%; IQR: 48-59%) were referred to neurologist, and 92 (25%; IQR: 10-37%) were referred to CT or MRI scan. Associated factors for referral were >1 headache diagnosis (aOR 1.75 [95% CI: 1.05-2.95]; P = 0.03), post-traumatic headache (aOR 2.53 [95% CI: 1.25-5.38]; P = 0.01), unspecific headache (aOR 2.04 [95% CI: 1.08-3.93]; P = 0.03), and using preventive treatment (aOR 2.75 [95% CI: 1.68-4.57]; P < 0.001).CONCLUSION: This study provides insights to how GPs manage patients with long-lasting headache. Focus should be on reducing opioids, increasing preventive treatment, and keeping more patients in primary care.
AB - BACKGROUND: Headache disorders are globally prevalent and insufficient treatment contribute to low quality of life, increased disability, and socioeconomic costs. However, headache can to a large extent be treated appropriately by general practitioners.OBJECTIVE: To explore general practitioners' (GPs') management of patients with headache lasting ≥6 months.METHODS: In this retrospective descriptive cross-sectional study based on medical audit, all GPs practicing in Vejle municipality (population 116,992), Denmark, were invited to review their latest 20 patients with headache. Outcome measures were headache diagnostics, treatment, and referrals. Factors associated with referral to neurological treatment were examined by logistic regression.RESULTS: Of 26 invited practices, 19 participated reporting on 367 patients with lasting headache (71.4% women; mean-age 48.5 years). One hundred and sixty-one patients had migraine (44%; IQR: 28-60%), 140 (38%; IQR: 25-44%) had tension-type headache; 243 (66%; IQR: 50-79%) used simple analgesics, 147 (40%; IQR: 29-59%) triptans, 37 (10%; IQR: 0-14%) opioids, 93 (25%; IQR: 20-35%) were prescribed preventive medication; 176 (48%; IQR: 48-59%) were referred to neurologist, and 92 (25%; IQR: 10-37%) were referred to CT or MRI scan. Associated factors for referral were >1 headache diagnosis (aOR 1.75 [95% CI: 1.05-2.95]; P = 0.03), post-traumatic headache (aOR 2.53 [95% CI: 1.25-5.38]; P = 0.01), unspecific headache (aOR 2.04 [95% CI: 1.08-3.93]; P = 0.03), and using preventive treatment (aOR 2.75 [95% CI: 1.68-4.57]; P < 0.001).CONCLUSION: This study provides insights to how GPs manage patients with long-lasting headache. Focus should be on reducing opioids, increasing preventive treatment, and keeping more patients in primary care.
KW - Adult
KW - Analgesics/therapeutic use
KW - Cross-Sectional Studies
KW - Denmark
KW - Female
KW - General Practice
KW - Headache/diagnosis
KW - Humans
KW - Male
KW - Middle Aged
KW - Migraine Disorders/diagnosis
KW - Practice Patterns, Physicians'/statistics & numerical data
KW - Referral and Consultation
KW - Retrospective Studies
KW - Tension-Type Headache/diagnosis
KW - practice management
KW - primary care
KW - CME
KW - headache
KW - neurology
UR - http://www.scopus.com/inward/record.url?scp=85201400318&partnerID=8YFLogxK
U2 - 10.1093/fampra/cmac121
DO - 10.1093/fampra/cmac121
M3 - Journal article
C2 - 36308304
SN - 0263-2136
VL - 41
SP - 470
EP - 476
JO - Family Practice
JF - Family Practice
IS - 4
ER -