Participants and headache diagnoses
The questionnaire response rate was 71% and the interview participation rate was 74%. Among the participants, 82% (93/113) had an interview and a physical and neurological examination at the clinic, whereas 18% (20/113) had an interview by telephone. Whether the participants had been interviewed in person or by phone made no difference to the frequency of the various headache diagnoses, medication use, medication overuse, physician or CAM contact.
A total of 113 participants (22% men and 78% women) had secondary chronic headaches not exclusively due to medication overuse.
Forty-two % had CPTH, 21% had CEH, 41% HACRS and 8% had other secondary chronic headache, i.e. 3 post-craniotomy, 1 diving related, 4 pregnancy related, and 1 post-meningitis.
The sum exceeds 100%, since the diagnoses are not mutually exclusive. Forty-one% had co-occurrence of migraine and 49% had co-occurrence of medication overuse.
Physician consultation pattern
Table shows the physician contact pattern.
Contact and treatment pattern in relation to secondary headache diagnoses
Thirty % (34/113) had never had contact with the health care system for their secondary chronic headache, while 70% (79/113) had had contact with their GP, 35% (40/113) had been referred to a neurologist and 5% (6/113) had been hospitalised for their secondary chronic headache. There was no gender difference in the physician contact pattern.
Complementary and alternative medicine
Table shows that 73% (82/113) had used CAM for their secondary chronic headache. Physiotherapy, acupuncture and chiropractic were most frequently used. Physiotherapy was most commonly used in CPTH, CEH and HACRS, i.e. 85%, 75% and 48%, respectively.
The use of CAM was significantly higher among those who had consulted a physician compared to those who had not (84% vs. 47%, p
Co-occurrence of migraine
Co-occurrence of migraine increased health care utilisation (physician contact (p
0.043), and hospitalisation (p
The overall use of CAM was not significantly influenced by migraine, although there was a tendency for a higher usage of CAM among people with than without co-occurrence of migraine.
Use of medication
Acute medication was used by 84%, and 19% used it on a daily basis. A higher proportion of participants with than without co-occurrence of migraine used acute medication (93% vs. 78%, p
0.024), while there was no gender difference. People using acute medication had significantly more physician contact than people not using acute medication (89% vs. 74%, p
0.045). People using acute medication had significantly more CAM use than people not using acute medication (89% vs. 71%, p
Contact with physicians was significantly influenced by medication overuse (82% vs. 59%, p
0.007), and proportions with none, primary and secondary physician contact level was also different for those with compared to those without medication overuse (Figure ). A higher proportion of those with than without medication overuse used CAM (82% vs. 64%, p
0.032). The distribution of medication overuse was similar in different subtypes of secondary chronic headaches. Fifty-eight% overused simple analgesics, mainly paracetamol and/or ibuprofen and 31% overused combination analgesics, usually a combination of paracetamol and codeine. Of the latter 53% also overused simple analgesics. The physician contact level was not influenced by type of medication overuse. The SDS score was significantly higher in those with than without medication overuse for all levels of physician contact (Figure ).
Physician contact levels for participants with secondary chronic headache without (dark grey) or with (light grey) medication overuse.
Figure 3 Severity Dependence Scale (SDS) scores in participants with secondary chronic headache with (black) or without (dashed) medication overuse vs. contact level. χ2, p<0.0035 for all contact levels. *Primary contact level (more ...)
Prophylactic treatment was used by 11% (12/113) and was not influenced by gender or co-occurrence of migraine.