Current diagnostic and therapeutic approaches in Italy vary widely between the different Headache Centres (HCs). In order to get a "picture" of the present-day situation in this country, we prepared a survey of 28 HCs. The rate of respondents was 75% (21 HCs out of 28 have responded). The survey consisted of two different stages: a retrospective stage and a prospective stage. In the first, retrospective stage, operators in each HC were asked to use a specially designed form to record all diagnoses made for first referrals seen at the HC between September 2000 and March 2001 (n = 4020), as well as the relevant codes corresponding to the diagnostic criteria of the International Headache Society Classification (IHS). The purpose of this stage was to evaluate the "epidemiology" of the primary or secondary headache forms diagnosed over a period of about 6 months. In the second, prospective stage, operators at each HC were asked to fill in a special form for each of the 50 consecutive patients who showed up for a visit at the HC from the time of their agreement to participate in the study (March 1, 2001) until the end of June 2001 (n = 884). The form comprised several sections and was so structured as to enable data collection about the patient's "status", i.e. his/her diagnosis, and any examinations taken or treatments administered either before or after the first visit at the HC. Overall, 51.4% (2067/4020) of the patients investigated in the retrospective stage were found to have migraine without aura (MO), 8.4% (339/4020) migraine with aura (MA), 9.4% (378/4020) and 9.1% (365/4020) episodic (ETTH) and chronic (CTTH) tension-type headache, respectively, and 3.1% (123/4020) cluster headache (CH). The prospective stage of the study showed that the average waiting time for admission to the HC was 77.5 days; half the cases (53.8%) had to wait 1 to 4 months for the first visit. A total of 462/884 patients (52.3%) were referred to the HC on previous headache diagnoses. Of these, 312/462 (67.5%) were found to be correct by the HC specialist, while 150/462 (32.5%) were not consistent with the diagnosis made at the end of the first visit. Upon admission to the HC, 24.4% (50/205) of MO cases, 27.7% (13/47) of MA cases, 16.9% (4/25) of ETTH cases and as much as 71.4% (15/21) of CTTH cases and 48.0% (12/25) of CH cases were judged by the HC specialist not to have been properly diagnosed. Of the 172 diagnoses made by GPs, 72 (41.9%) were not consistent with those of the HC specialist; nor did 32/66 diagnoses (48.5%) made by specialists other than neurologists. Overall, 366/884 patients (41.4%) had had an instrumental examination taken prior to the visit, 867 (98.1%) had taken an anti-headache drug or attempted a non -pharmacological treatment, and only 237 (26.8%) had their headache treated with molecules exhibiting a preventive action. Data about "post-visit" procedures showed that an EEG was prescribed in 121 cases and a blood test in 91 cases even thought only in 25/884 cases (2.8%) was made a diagnosis of secondary headache. Preventive therapy was suggested to 549/884 patients (62.1%).
|Translated title of the contribution||The management of the headache patient in 21 Italian specialist centres|
|Number of pages||27|
|Publication status||Published - 2002|
ASJC Scopus subject areas
- Clinical Neurology