1
|
Evlice A, Genç H, Uluduz D, Baykan B, Bolay H, Unal-Cevik I, Kissani N, Luvsannorov O, Togha M, Ozge A. Secondary headache disorders in Turkey, the Middle East, Asia, and Africa: A cross-sectional, multicenter study. Cephalalgia 2023; 43:3331024231194024. [PMID: 37592903 DOI: 10.1177/03331024231194024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND This multicenter cross-sectional study aimed to determine the frequency and characteristics of secondary headaches in different geographic regions, including Turkey, the Middle East, Asia, and Africa. METHODS Patients were admitted to the study on a particular day each week for five consecutive weeks between 1 April and 16 May 2022. Before the study, all researchers underwent a constructed briefing about the use and code of the ICHD-3 criteria. The study was conducted in two stages. In the first stage, data on secondary headaches were compared between the regions. In the second stage, the sub-diagnoses of secondary headaches were analyzed only in Turkey. RESULTS A total of 4144 (30.0%) of the 13,794 patients reported headaches as the main symptoms at admission. A total of 422 patients were excluded from the study. In total, 1249 (33.4%) of 3722 patients were diagnosed as having secondary headaches (Turkey [n = 1039], Middle East [n = 80], Asia [n = 51], Africa [n = 79]). The frequency of secondary headaches (Turkey 33.6%, Africa 30.1%, Middle East 35.5%, Asia 35.4%) did not differ significantly between the regions (p > 0.05). The most common subtype of secondary headaches was headache attributed to substances or their withdrawal in all the studied regions. There was a female predominance in all regions, but it was lower in Africa than in Turkey. The severity and density of headaches differed significantly between the regions, with patients from Africa reporting milder pain than patients from other regions. In Turkey, the most common sub-diagnoses of secondary headaches were medication overuse headache, idiopathic intracranial hypertension, and cervicogenic headache. CONCLUSION In the present study, one in three patients with a headache had a secondary headache. Headache attributed to substances or their withdrawal was the most common subtype of secondary headaches in all the studied regions. The female predominance of secondary headaches was lower in Africa than in Turkey. The severity and density of headaches differed significantly between regions, with patients from Africa reporting milder pain.
Collapse
Affiliation(s)
- Ahmet Evlice
- Department of Neurology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hamit Genç
- Department of Neurology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Derya Uluduz
- Department of Neurology, Istanbul University, Cerrahpasa Faculty of Medicine, İstanbul, Turkey
| | - Betul Baykan
- Istanbul University, Istanbul Faculty of Medicine, EMAR Medical Center, İstanbul, Turkey
| | - Hayrunnisa Bolay
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Isin Unal-Cevik
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Najib Kissani
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Otgonbayar Luvsannorov
- Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mansoureh Togha
- Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
| | - Aynur Ozge
- Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey
| |
Collapse
|
2
|
Agosti R, Parzini C, Findling O, Myers P, Petersen JA, Ryvlin P, Sandor P, Stallmach M, Zecca C, Snellman J, Ritter S, Arzt ME, Rohrer S, Gantenbein AR. Prevalence and Burden of Migraine in Switzerland: Cross-Sectional Study in ten Specialised Headache Centres from the BECOME Study. Pain Ther 2023; 12:575-591. [PMID: 36842093 PMCID: PMC10036704 DOI: 10.1007/s40122-023-00484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/03/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION There is limited real-world evidence on the burden of migraine among patients with prior preventive treatment failure (PPTF). In the BECOME Swiss subanalysis, we aimed to assess current prevalence of PPTF in patients with migraine seen at specialised headache centres in Switzerland and burden of migraine in these patients. Furthermore, we assessed this burden in subgroups stratified by monthly migraine days (MMDs) and number of PPTFs. METHODS BECOME was a prospective, multicentre, non-interventional two-part study conducted in 17 countries across Europe and Israel. This subanalysis includes patients visiting ten headache specialist centres in Switzerland. In part 1, patients visiting the centres over 3 months were screened by physicians for frequency of PPTF, MMD and other migraine characteristics. Patients with ≥ 1 PPTF and ≥ 4 MMDs were invited to take part in part 2. The primary endpoint was the proportion of patients with ≥ 1 PPTF (part 1). Other endpoints included proportion of patients specified by number of PPTF and MMD (part 1, part 2), and impact of migraine on patient-reported outcomes (PROs; part 2). RESULTS Patients (1677) from ten Swiss centres were included in part 1, of which 855 (51.0%) reported ≥ 1 PPTF. One hundred fifty-five patients were included in part 2: 6.5% reported ≥ 4 PPTFs and 43.2% reported ≥ 15 MMDs. Mean EuroQoL 5 and EuroQoL visual analogue scale (EQ-VAS) were 0.8 ± 0.2 and 69.6 ± 20.2, respectively, suggesting a mild level of impairment in the daily functioning and self-reported health of the patients. Mean six-item Headache Impact Test (HIT-6) and modified Migraine Disability Assessment (mMIDAS) scores were 63.3 ± 6.5 and 22.7 ± 21.8, respectively, corresponding to severe migraine burden. Patients also reported impairment in work-related productivity and general activities (48.6 ± 22.8) but no associations of anxiety (7.2 ± 4.4) or depression (6.0 ± 4.4) with migraine were noted. Burden of migraine increased with increasing frequency of PPTF and MMD. CONCLUSIONS Migraine-related quality of life, as well as work productivity are significantly affected in Swiss patients with migraine. Increasing migraine burden is associated with increasing migraine frequency and prior treatment failures.
Collapse
Affiliation(s)
- Reto Agosti
- Kopfwehzentrum Hirslanden Zürich, Forchstrasse 424, 8702, Zollikon, Switzerland
| | - Catherine Parzini
- Cabinet Dr. med. Catherine Parzini, 10 Place du Marché-1227, Carouge, Geneva, Switzerland
| | - Oliver Findling
- Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Peter Myers
- Cabinet Dr. med. Peter John Myers, Neurologue FMH7, Ruelle du Couchant, 1207, Geneva, Switzerland
| | - Jens A Petersen
- University Hospital Zurich and Neurozentrum, Schänzlistrasse 45, 3013, Bern, Switzerland
| | - Philippe Ryvlin
- CHUV Departement des Neurosciences Cliniques, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Peter Sandor
- RehaClinic AG, Quellenstrasse 34, 5330, Bad Zurzach, Switzerland
- University of Zurich, Rämistrasse 71, 8006, Zürich, Switzerland
- ZURZACH Care AG, Quellenstrasse 34, 5330, Bad Zurzach, Germany
| | - Matthias Stallmach
- Neurologie Am Schaulager, Emil-Frey-Str. 85, 4142, Münchenstein, Switzerland
| | - Chiara Zecca
- Neurocenter of Southern Switzerland, EOC, Ospedale Regionale di Lugano, Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Via Giuseppe Buffi 13, 6900, Lugano, Switzerland
| | | | - Shannon Ritter
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936, USA
| | - Michael E Arzt
- Novartis Pharma Schweiz AG, Suurstoffi 14, 6343, Rotkreuz, Switzerland
| | - Simon Rohrer
- Novartis Pharma Schweiz AG, Suurstoffi 14, 6343, Rotkreuz, Switzerland
| | | |
Collapse
|
3
|
Zhu S, Wu T, Leese J, Li LC, He C, Yang L. What is the value and impact of the adaptation process on quality indicators for local use? A scoping review. PLoS One 2022; 17:e0278379. [PMID: 36480565 PMCID: PMC9731415 DOI: 10.1371/journal.pone.0278379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Quality indicators (QIs) are designed for improving quality of care, but the development of QIs is resource intensive and time consuming. OBJECTIVE To describe and identify the impact and potential attributes of the adaptation process for the local use of existing QIs. DATA SOURCES EMBASE, MEDLINE, CINAHL and grey literature were searched. STUDY SELECTION Literatures operationalizing or implementing QIs that were developed in a different jurisdiction from the place where the QIs were included. RESULTS Of 7704 citations identified, 10 out of 33 articles were included. Our results revealed a lack of definition and conceptualization for an adaptation process in which an existing set of QIs was applied. Four out of ten studies involved a consensus process (e.g., Delphi or RAND process) to determine the suitability of QIs for local use. QIs for chronic conditions in primary and secondary settings were mostly used for adaptation. Of the ones that underwent a consensus process, 56.3 to 85.7% of original QIs were considered valid for local use, and 2 to 21.8% of proposed QIs were newly added. Four attributes should be considered in the adaptation: 1) identifying areas/conditions; 2) a consensus process; 3) proposing adapted QIs; 4) operationalization and evaluation. CONCLUSION The existing QIs, although serving as a good starting point, were not adequately adapted before for use in a different jurisdiction from their origin. Adaptation of QIs under a systematic approach is critical for informing future research planning for QIs adaptation and potentially establishing a new pathway for healthcare improvement.
Collapse
Affiliation(s)
- Siyi Zhu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- * E-mail: (SZ); (CH); (LY)
| | - Tao Wu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jenny Leese
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda C. Li
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chengqi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- * E-mail: (SZ); (CH); (LY)
| | - Lin Yang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- * E-mail: (SZ); (CH); (LY)
| |
Collapse
|
4
|
Diagnosis and management of headache disorders in osteopathic practice: A qualitative study. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
5
|
Steiner TJ, Birbeck GL, Jensen RH, Martelletti P, Stovner LJ, Uluduz D, Leonardi M, Olesen J, Katsarava Z. The Global Campaign turns 18: a brief review of its activities and achievements. J Headache Pain 2022; 23:49. [PMID: 35448941 PMCID: PMC9022610 DOI: 10.1186/s10194-022-01420-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/10/2022] [Indexed: 01/11/2023] Open
Abstract
The Global Campaign against Headache, as a collaborative activity with the World Health Organization (WHO), was formally launched in Copenhagen in March 2004. In the month it turns 18, we review its activities and achievements, from initial determination of its strategic objectives, through partnerships and project management, knowledge acquisition and awareness generation, to evidence-based proposals for change justified by cost-effectiveness analysis.
Collapse
Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway. .,Division of Brain Sciences, Imperial College London, London, UK.
| | - Gretchen L Birbeck
- UTH Neurology Research Office, University of Zambia, Lusaka, Zambia.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, Norwegian Advisory Unit On Headaches,, St Olavs Hospital, Trondheim, Norway
| | - Derya Uluduz
- Neurology Department, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Matilde Leonardi
- Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico C Besta, NeurologyMilan, Italy
| | - Jes Olesen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Zaza Katsarava
- Centre of Neurology, Geriatric Medicine and Early Rehabilitation, Evangelical Hospital, Unna, Germany.,Medical Faculty, University of Essen, Essen, Germany
| |
Collapse
|
6
|
Burden of Migraine in Patients With Preventive Treatment Failure Attending European Headache Specialist Centers: Real-World Evidence From the BECOME Study. Pain Ther 2021; 10:1691-1708. [PMID: 34643891 PMCID: PMC8586314 DOI: 10.1007/s40122-021-00331-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Migraine is consistently ranked as one of the most disabling neurological conditions in the world, often causing a substantial impairment of daily activities and quality of life. It also carries a high economic burden of direct and indirect healthcare costs. Patients with difficult-to-treat migraine often cycle through different preventive therapies, but real-world prospective evidence describing the burden of migraine in patients with prior preventive treatment failure (PPTF) in Europe is limited. In BECOME, we aimed to characterize and assess the prevalence and burden of migraine in patients with PPTF attending specialist headache centers in Europe and Israel. Furthermore, we assessed this burden in pre-specified subgroups based on the frequency of monthly migraine days (MMD) and number of PPTFs. METHODS BECOME was a prospective, non-interventional study conducted in two concurrent parts across 17 countries in Europe and Israel. In part 1, patients visiting the centers over a 3-month period were screened for frequency of PPTF, MMD, and other characteristics. In part 2, patients from part 1 with ≥ 1 PPTF and ≥ 4 MMD were enrolled, and impact of migraine on patient-reported outcomes, and healthcare resource utilization (HRU) were examined. RESULTS In part 1 (n = 20,837), 62.2% of patients reported ≥ 1 PPTF. In part 2 (n = 2419), 15.3% of patients reported ≥ 4 PPTF. In part 2, the migraine burden measured by the EuroQoL 5 dimensions 5 level (EQ-5D-5L) questionnaire indicated an impact of at least moderate severity in performing usual activities in 26.5% of patients, pain/discomfort in 51.2%, and 26.1% reported being at least moderately anxious/depressed. Most patients reported a severe impact on daily activities and disability due to migraine. Abnormal Hospital Anxiety and Depression subscale scores of ≥ 11 were observed in 29% (anxiety) and 19.8% (depression) of the population. In part 2, analysis of HRU showed 21.2% patients visited an emergency department and 8.4% were hospitalized for headache/migraine in the past year. CONCLUSIONS This study provides real-world evidence of the high personal, social, and HRU burden of migraine in Europe and Israel.
Collapse
|
7
|
Tinelli M, Leonardi M, Paemeleire K, Raggi A, Mitsikostas D, de la Torre ER, Steiner TJ. Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions. J Headache Pain 2021; 22:90. [PMID: 34380429 PMCID: PMC8359596 DOI: 10.1186/s10194-021-01305-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. METHODS Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. RESULTS The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. CONCLUSIONS This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe.
Collapse
Affiliation(s)
- Michela Tinelli
- Care Policy Evaluation Centre, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | | | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Dimos Mitsikostas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| |
Collapse
|
8
|
Steiner TJ, Jensen R, Katsarava Z, Stovner LJ, Uluduz D, Adarmouch L, Al Jumah M, Al Khathaami AM, Ashina M, Braschinsky M, Broner S, Eliasson JH, Gil-Gouveia R, Gómez-Galván JB, Gudmundsson LS, Herekar AA, Kawatu N, Kissani N, Kulkarni GB, Lebedeva ER, Leonardi M, Linde M, Luvsannorov O, Maiga Y, Milanov I, Mitsikostas DD, Musayev T, Olesen J, Osipova V, Paemeleire K, Peres MFP, Quispe G, Rao GN, Risal A, de la Torre ER, Saylor D, Togha M, Yu SY, Zebenigus M, Zewde YZ, Zidverc-Trajković J, Tinelli M. Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description. J Headache Pain 2021; 22:78. [PMID: 34289806 PMCID: PMC8293530 DOI: 10.1186/s10194-021-01265-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Abstract
In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the "patient journey") with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.
Collapse
Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.
- Division of Brain Sciences, Imperial College London, London, UK.
| | - Rigmor Jensen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Zaza Katsarava
- Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Derya Uluduz
- Neurology Department, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Latifa Adarmouch
- Community Medicine and Public Health Department, Cadi Ayyad University School of Medicine, Marrakech, Morocco
| | - Mohammed Al Jumah
- Department of Neurosciences, King Fahad Medical City, MOH, Riyadh, Saudi Arabia
| | - Ali M Al Khathaami
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Messoud Ashina
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Mark Braschinsky
- Headache Clinic, Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Susan Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Jon H Eliasson
- Department of Neurology, Centralsjukhuset, Kristianstad, Sweden
| | - Raquel Gil-Gouveia
- Headache Centre, Neurology Department, Hospital da Luz, Lisbon, Portugal
| | | | - Larus S Gudmundsson
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Akbar A Herekar
- Department of Anesthesiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nfwama Kawatu
- Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Najib Kissani
- Laboratory of Clinical and Experimental Neuroscience, Faculty of Medicine, Université Cadi Ayyad Marrakech, Marrakech, Morocco
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakech, Morocco
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Elena R Lebedeva
- Department of Neurology and Neurosurgery, The Ural State Medical University, Yekaterinburg, Russia
- International Headache Centre "Europe-Asia", Yekaterinburg, Russia
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
- Tjörn Headache Clinic, Rönnäng, Sweden
| | - Otgonbayar Luvsannorov
- Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Youssoufa Maiga
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Ivan Milanov
- Department of Neurology, University Hospital of Neurology and Psychiatry "St Naum", Medical University Sofia, Sofia, Bulgaria
| | - Dimos D Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Teymur Musayev
- Chief of Department of Health Organization, Ministry of Health, Baku, Azerbaijan
| | - Jes Olesen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Vera Osipova
- Moscow Research Clinical Centre for Neuropsychiatry, Moscow, Russian Federation
- University Headache Clinic, Moscow, Russian Federation
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Mario F P Peres
- Institute of Psychiatry, University of São Paulo, Hospital Albert Einstein, São Paulo, Brazil
| | - Guiovanna Quispe
- Department of Neurology, Hospital Luis Negreiros Vega, Callao, Lima, Peru
| | - Girish N Rao
- Department of Epidemiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ajay Risal
- Department of Psychiatry, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Kavre, Nepal
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | | | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Mansoureh Togha
- Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Iranian Center of Neurological Researches, Institute of Neuroscience, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheng-Yuan Yu
- International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Mehila Zebenigus
- Department of Neurology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Zenebe Zewde
- Department of Neurology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Michela Tinelli
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| |
Collapse
|
9
|
Lenz B, Katsarava Z, Gil-Gouveia R, Karelis G, Kaynarkaya B, Meksa L, Oliveira E, Palavra F, Rosendo I, Sahin M, Silva B, Uludüz D, Ural YZ, Varsberga-Apsite I, Zengin ST, Zvaune L, Steiner TJ. Headache service quality evaluation: implementation of quality indicators in primary care in Europe. J Headache Pain 2021; 22:33. [PMID: 33910500 PMCID: PMC8080333 DOI: 10.1186/s10194-021-01236-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. METHODS We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients' records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. RESULTS The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 ("headache") rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. CONCLUSIONS The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients' satisfaction is not, on its own, a good indicator of service quality.
Collapse
Affiliation(s)
- B. Lenz
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Z. Katsarava
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Republic of Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - G. Karelis
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | | | - L. Meksa
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | - E. Oliveira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - F. Palavra
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - I. Rosendo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Family Health Unit “Coimbra Centro”, Coimbra, Portugal
| | - M. Sahin
- Kartal 10 Nolu ASM Istanbul, Istanbul, Turkey
| | - B. Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Family Health Unit “Pulsar”, Coimbra, Portugal
| | - D. Uludüz
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - I. Varsberga-Apsite
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | | | - L. Zvaune
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | - T. J. Steiner
- Norwegian University of Science and Technology, Trondheim, Norway
- Division of Neuroscience, Imperial College London, London, UK
| | - on behalf of European Headache Federation and Lifting The Burden: the Global Campaign against Headache
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Republic of Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- Hospital da Luz Headache Center, Lisbon, Portugal
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
- Kagıthane Yahya Kemal ASM, Istanbul, Turkey
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Family Health Unit “Coimbra Centro”, Coimbra, Portugal
- Kartal 10 Nolu ASM Istanbul, Istanbul, Turkey
- Family Health Unit “Pulsar”, Coimbra, Portugal
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
- Esenler Havaalanı ASM, Istanbul, Turkey
- Bagcılar Yıldıztepe ASM, Istanbul, Turkey
- Norwegian University of Science and Technology, Trondheim, Norway
- Division of Neuroscience, Imperial College London, London, UK
| |
Collapse
|
10
|
Chiodo L, Grillo E, Lahouiri E, Marchina M, Pedrazzoli M, Ferraris M. The Italian Chapter of the MOST Project: Specific Changes in the Organization of Headache Centres Can Help Improve the Patient Journey. Neurology 2021. [DOI: 10.17925/usn.2021.17.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
11
|
Wongsiriroj S, Grillo E, Levi S, Zielman R, Lahouiri E, Marchina M, Pedrazzoli M, Ferraris M. Management of Migraine and the Accessibility of Specialist Care: Findings from an Extended Multinational Survey (My Migraine Center Survey). Neurol Ther 2020; 9:551-565. [PMID: 32767268 PMCID: PMC7606425 DOI: 10.1007/s40120-020-00205-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The parent study was a survey in 28 headache centers (6 countries) which identified five potential root causes for long waiting lists that limit patient access to specialist care. Here we performed an extension of the parent study to increase the panel of centers contacted, the representativeness of the analysis, and the statistical validity of the results, and to explore the role of dedicated headache clinics, triage, and specialized nurses. METHODS We conducted a 19-question survey using a sample of 239 headache centers (16 countries). The five-area framework identified in the parent study was confirmed and further developed by describing treatment center archetypes according to their setting (general neurology versus dedicated clinic) and resources available within the center (number of healthcare professional [HCPs] full-time-equivalent positions). RESULTS In total, 474 HCPs were interviewed across 16 countries. The proportion of patients with chronic migraine and episodic migraine varied across centers and countries. There was limited access to specialized centers in this enlarged sample; with global average waiting list of 3.7 months for the first visit and 2.5 months for the follow-up visit. Long waiting lists for headache patient care is a major issue in several countries, with the waiting lists for new patient visits extending up to 14 months. The presence of a dedicated nurse was correlated positively with the use of triage for prioritization of patient access (correlation coefficient: 0.85) and completing migraine diary (0.71). CONCLUSION This study confirmed differences across treatment center archetypes in terms of patients, waiting lists, level of delegation to nurse, and patient education and compliance, and provides support for the potential benefit of dedicated clinical settings for headache patients. The survey highlighted the potential role of nurses in patient education and waiting list prioritization, consequently benefiting headache centers.
Collapse
|
12
|
Pascual J, Pozo-Rosich P, Carrillo I, Rodríguez-Justo S, Jiménez-Hernández D, Layos-Romero A, Bailón-Santamaría C, Torres A, Martínez-García A, Ignacio E, Mira JJ. Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report. BMJ Open 2020; 10:e037190. [PMID: 33127628 PMCID: PMC7604819 DOI: 10.1136/bmjopen-2020-037190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/15/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Headache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process. PURPOSE To establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare. METHOD A qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness. RESULTS Seven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%). CONCLUSIONS This proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.
Collapse
Affiliation(s)
- Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla and Valdecilla Biomedical Research Institute, Santander, Cantabria, Spain
- Department of Medicine, University of Cantabria, Santander, Cantabria, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
- Headache Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Irene Carrillo
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Sant Joan d'Alacant, Valencia Region, Spain
- Department of Health Psychology, Miguel Hernández University, Elche, Valencia Region, Spain
| | | | - Dolores Jiménez-Hernández
- Neurology Department, Virgen del Rocío University Hospital, Seville, Andalusia, Spain
- Faculty of Medicine, University of Seville, Seville, Andalusia, Spain
| | - Almudena Layos-Romero
- Headache Unit, Neurology Department, University Hospital of Albacete, Albacete, Castile-La Mancha, Spain
| | - Cristina Bailón-Santamaría
- Service of Neurology, University Hospital Marqués de Valdecilla and Valdecilla Biomedical Research Institute, Santander, Cantabria, Spain
| | - Antonio Torres
- Andalusian Agency for Healthcare Quality, Seville, Andalusia, Spain
| | - Alba Martínez-García
- Department of Health Psychology, Miguel Hernández University, Elche, Valencia Region, Spain
| | - Emilio Ignacio
- Department of Nursing and Physiotherapy, University of Cadiz, Cadiz, Andalusia, Spain
| | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University, Elche, Valencia Region, Spain
- Alicante-Sant Joan Health District, Alicante, Valencia Region, Spain
| |
Collapse
|
13
|
Pozo-Rosich P, Martínez-García A, Pascual J, Ignacio E, Guerrero-Peral ÁL, Balseiro-Gómez J, Porta-Etessam J, Latorre-González G, Layos-Romero A, Lucas C, Mira JJ. Quality assurance in specialized headache units in Spain: an observational prospective study. J Headache Pain 2019; 20:73. [PMID: 31238877 PMCID: PMC6734389 DOI: 10.1186/s10194-019-1020-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the quality of the therapeutic approach in Specialized Headache Units in Spain. Methods An observational (prospective) study was conducted. Anonymized data of 313 consecutive patients during a defined period of time were analyzed and a comparison of performance in 13 consensual quality indicators between Specialized Headache Units and neurology consultations was calculated. Specialized Units and neurology consultations represented the type of provision that Spaniards receive in hospitals. Results The consensus benchmark standard was reached for 8/13 (61%) indicators. Specialized Headache Units performed better in the indicators, specifically in relation to accessibility, equity, safety, and patient satisfaction. Patients attended in Specialized Headache Units had more complex conditions. Conclusion Although there is variability among Specialized Headache Units, the overall quality was generally better than in traditional neurology consultations in Spain.
Collapse
Affiliation(s)
- Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Julio Pascual
- Marqués de Valdecilla Hospital, Santander, Spain.,Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | | | - Ángel L Guerrero-Peral
- Headache Unit, Neurology Department, University Hospital of Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | | | | | | | - César Lucas
- Neurology Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - José J Mira
- Alicante-Sant Joan Health District, Alicante, Spain.,Health Services Research in Chronic Illnesses Network, REDISSEC, Alicante, Spain
| |
Collapse
|
14
|
Steiner TJ, Göbel H, Jensen R, Lampl C, Paemeleire K, Linde M, Braschinsky M, Mitsikostas D, Gil-Gouveia R, Katsarava Z. Headache service quality: the role of specialized headache centres within structured headache services, and suggested standards and criteria as centres of excellence. J Headache Pain 2019; 20:24. [PMID: 30832585 PMCID: PMC6734362 DOI: 10.1186/s10194-019-0970-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/11/2019] [Indexed: 01/11/2023] Open
Abstract
In joint initiatives, the European Headache Federation and Lifting The Burden have described a model of structured headache services (with their basis in primary care), defined service quality in this context, and developed practical methods for its evaluation.Here, in a continuation of the service quality evaluation programme, we set out ten suggested role- and performance-defining standards for specialized headache centres operating as an integral component of these services. Verifiable criteria for evaluation accompany each standard. The purposes are five-fold: (i) to inspire and promote, or stimulate the establishment of, specialized headache centres as centres of excellence; (ii) to define the role of such centres within optimally structured and organized national headache services; (iii) to set out criteria by which such centres may be recognized as exemplary in their fulfilment of this role; (iv) to provide the basis for, and to initiate and motivate, collaboration and networking between such centres both nationally and internationally; (v) ultimately to improve the delivery and quality of health care for headache.
Collapse
Affiliation(s)
- T. J. Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - H. Göbel
- Kiel Headache Centre, Kiel Neurological Pain and Headache Centre, Kiel, Germany
| | - R. Jensen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup Hospital, Glostrup, Denmark
| | - C. Lampl
- Headache Medical Centre, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - K. Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - M. Linde
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, Norway
| | - M. Braschinsky
- Headache Clinic, Neurology Clinic, Tartu University Clinics, Tartu, Estonia
| | - D. Mitsikostas
- Neurology Department A, Aeginition Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Z. Katsarava
- Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - on behalf of the European Headache Federation and Lifting The Burden: the Global Campaign against Headache
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
- Kiel Headache Centre, Kiel Neurological Pain and Headache Centre, Kiel, Germany
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup Hospital, Glostrup, Denmark
- Headache Medical Centre, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Headache Clinic, Neurology Clinic, Tartu University Clinics, Tartu, Estonia
- Neurology Department A, Aeginition Hospital, National & Kapodistrian University of Athens, Athens, Greece
- Hospital da Luz Headache Center, Lisbon, Portugal
- Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| |
Collapse
|
15
|
Tai MLS, Yap JF, Goh CB. Dietary trigger factors of migraine and tension-type headache in a South East Asian country. J Pain Res 2018; 11:1255-1261. [PMID: 29988763 PMCID: PMC6029602 DOI: 10.2147/jpr.s158151] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The literature on the dietary trigger factors of headache among the South East Asians is limited. OBJECTIVE The objective of the study was to examine the dietary trigger factors of migraine and tension-type headache (TTH) in Malaysian patients, consisting of Malays, Chinese and Indians. METHODS In this prospective cross-sectional study, patients presenting with migraine and TTH to a neurology clinic between April 2010 and June 2017 were recruited. The patients were given a comprehensive dietary list consisting of 25 specified types of food and drink items as well as other unspecified types of food and drink items which were possible dietary triggers. The data on these dietary triggers and missing meals were collected. RESULTS A total of 684 patients with headache (319 migraine and 365 TTH patients) were recruited. One hundred and fifty-eight (23.1%) patients had missing meals as trigger. Two hundred and fifty-five (37.3%) patients had dietary triggers; 141 (44.2%) patients with migraine and 114 (31.2%) patients with TTH had dietary triggers. Eighty-four (52.8%) Malay, 28 (41.8%) Chinese, 25 (32.5%) Indian migraine patients and five (38.5%) migraine patients from other ethnic groups, had dietary triggers. Some 58 (40.0%) Malay, 27 (25.2%) Chinese, 22 (23.9%) Indian patients and 7 (29.2%) patients from other ethnic groups with TTH had dietary triggers. The most common dietary trigger factors were coffee (19.9%), chocolate (7.5%) and food rich in monosodium glutamate (5.6%). Logistic regression showed that chocolate (OR 2.16, 95% CI 1.06-4.41, p = 0.035) and coffee (OR 1.73, 95% CI 1.12-2.68, p = 0.014) were significantly associated with migraine compared to TTH. CONCLUSION Chocolate and coffee significantly triggered migraine compared to TTH. Inter-ethnic differences were observed for dietary trigger factors.
Collapse
Affiliation(s)
- Mei-Ling Sharon Tai
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
| | - Jun Fai Yap
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
| | - Cheng Beh Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
- Department of Medicine, Sultan Ismail Hospital, Johor Bahru, Johor, Malaysia
| |
Collapse
|
16
|
Kamali M, Seifadini R, Kamali H, Mehrabani M, Jahani Y, Tajadini H. Efficacy of combination of Viola odorata, Rosa damascena and Coriandrum sativum in prevention of migraine attacks: a randomized, double blind, placebo-controlled clinical trial. Electron Physician 2018; 10:6430-6438. [PMID: 29765566 PMCID: PMC5942562 DOI: 10.19082/6430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/21/2017] [Indexed: 01/03/2023] Open
Abstract
Background Migraine is the second most common type of headache after tension headaches. In Iranian traditional medicine several herbal drugs are used for the treatment of headache. Including, a product of Iranian traditional medicine, a combination of Viola odorata L. flowers, Rosa damascena L. flowers and Coriandrum sativum L. fruits. Objective To determine the effectiveness of a combination of Viola odorata flowers, Rosa damascene flowers and Coriandrum sativum fruits on severity, duration and frequency of migraine headaches. Methods This randomized, double blind, placebo-controlled clinical trial was performed on 88 patients who had migraine and visited Besat Neurology Clinic No. 4 at Kerman University of Medical Sciences, Kerman, Iran, from September 2016 to march 2017. Patients were randomly divided into the intervention (n=44) or placebo group (n=44). The intervention group received a product of Iranian traditional medicine, a combination of Viola odorata L. flowers, Rosa damascena L. flowers and Coriandrum sativum L. fruits in 500 mg capsules three times a day and propranolol 20mg tablet twice a day, and the control group received placebo capsules (500mg) three times a day and propranolol 20mg tablet twice a day for four weeks. Patients were asked to report the frequency, duration and severity of their headaches in designed forms at home. Then at the end of the 2nd and 4th weeks of treatment, patients were followed for clinical efficacy. Results In terms of duration, frequency and severity of headaches between the two groups of herbal medicine and placebo, the behavior of the two protocols was changed over time (p<0.001). During the 4 weeks, the time and drug interactions, were significant (p <0.001). In other words, the pattern of changes to the two protocols over time, was different. Also, at the end of the 4th week, there was a significant difference between the two groups (p<0.001). Conclusion The study findings suggest that the Iranian traditional product combination of Viola odorata flowers, Rosa damascena flowers and Coriandrum sativum fruits may be effective in improving headaches in patients with migraine. Clinical trial registration The trial was registered at the Iranian registry of clinical trials (IRCT: www.irct.ir) with registered NO. IRCT 2016110830776N1. Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Collapse
Affiliation(s)
- Mohadese Kamali
- MD, Persian Medicine Student, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Department of Persian Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Rostam Seifadini
- MD, Neurologist, Assistant Professor, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Hoda Kamali
- MD, Neurologist, Assistant Professor, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Mehrabani
- Pharmacognosist, Professor, Department of Pharmacognosy, Herbal and Traditional Medicines Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- PhD of Biostatistics, Assistant Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Haleh Tajadini
- Department of Persian Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran.,MD, PhD of Persian Medicine, Assistant Professor, Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
17
|
Steiner TJ, Lipton RB. The Headache-Attributed Lost Time (HALT) Indices: measures of burden for clinical management and population-based research. J Headache Pain 2018; 19:12. [PMID: 29396646 PMCID: PMC5796955 DOI: 10.1186/s10194-018-0837-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 01/10/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The burden attributable to headache disorders has multiple components: a simple measure summarising them all does not exist. The Migraine Disability Assessment (MIDAS) instrument has proved useful, estimating productive time lost in the preceding 3 months due to the disabling effect of headache. We developed adaptations of MIDAS for purposes of the Global Campaign against Headache, embracing epidemiological studies and the provision of clinical management aids. METHODS We reviewed the structure, content, wording and scoring of MIDAS and made revisions, developing the Headache-Attributed Lost Time (HALT) Indices in three versions. Over 10 years, these were employed in multiple epidemiological and clinical studies in countries worldwide. RESULTS In the original HALT-90, we made no changes to the structure and scoring of MIDAS, but used wording in questions 1-4 that we believed would be more widely understood and more easily translated into other languages. Of the two alternative versions, HALT-30 kept the same structure, question format and wording except that "3 months" was replaced by "1 month". HALT-7/30 was a variant of HALT-30: focusing only on lost work time for population-based studies of headache-attributed burden, it enquired into lost days in the preceding month (30 days) and week (7 days). CONCLUSIONS Three versions of the HALT Indices serve different purposes as measures of headache-attributed burden, and offer different means of scoring. In studies using HALT as a population measure, there is no need to reflect the states of individuals, whereas a measure over shorter periods than 3 months is likely to be more reliable through better recall. Assessment of individual patients prior to treatment may best estimate impact if enquiry is made into the preceding 90 days, except in cases where headache is highly frequent. Follow-up in clinical management may be better served by assessments over 30 rather than 90 days.
Collapse
Affiliation(s)
- T J Steiner
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
- Division of Brain Sciences, Imperial College London, London, UK.
| | - R B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
18
|
Pellesi L, Benemei S, Favoni V, Lupi C, Mampreso E, Negro A, Paolucci M, Steiner TJ, Ulivi M, Cevoli S, Guerzoni S. Quality indicators in headache care: an implementation study in six Italian specialist-care centres. J Headache Pain 2017; 18:55. [PMID: 28477307 PMCID: PMC5419950 DOI: 10.1186/s10194-017-0762-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/27/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Headache disorders are highly prevalent, and have a substantial and negative impact on health worldwide. They are largely treatable, but differences in structure, objectives, organization and delivery affect the quality of headache care. In order to recognize and remedy deficiencies in care, the Global Campaign against Headache, in collaboration with the European Headache Federation, recently developed a set of quality indicators for headache services. These require further assessment to demonstrate fitness for purpose. This is their first implementation to evaluate quality in headache care as a multicentre national study. METHODS Between September and December 2016, we applied the quality indicators in six Italian specialist headache centres (Bologna, Firenze, Modena, Padova, Roma Campus Bio-Medico and Roma Sapienza). We used five previously developed assessment instruments, translated into Italian according to Lifting The Burden's translation protocol for hybrid documents. We took data from 360 consecutive patients (60 per centre) by questionnaire and from their medical records, and by different questionnaires from their health-care providers (HCPs), including physicians, nurses, psychologists and nursing assistants. RESULTS The findings, comparable between centres, confirmed the feasibility and practicability of using the quality indicators in Italian specialist headache centres. The questionnaires were easily understood by HCPs and patients, and were not unduly time-consuming. Diagnoses were almost all (> 97%) according to ICHD criteria, and routinely (100%) reviewed during follow-up. Diagnostic diaries were regularly used by 96% of physicians. Referral pathways from primary to specialist care existed in five of the six clinics, as did urgent referral pathways. Instruments to assess disability and quality of life were not used regularly, a deficiency that needs to be addressed. CONCLUSION This Italy-wide survey confirmed in six specialist centres that the headache service quality indicators are fit for purpose. By establishing majority practice, identifying commonalities and detecting deficits as a guide to quality improvement, the quality indicators may be used to set benchmarks for quality assessment. The next step is extend use and evaluation of the indicators into non-specialist care.
Collapse
Affiliation(s)
- L Pellesi
- Medical Toxicology - Headache Centre, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy.
| | - S Benemei
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - V Favoni
- IRCCS Institute of Neurological Sciences of Bologna, Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Bologna, Italy
| | - C Lupi
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - E Mampreso
- Department of Neurosciences, Headache Centre, University of Padua, Padua, Italy
| | - A Negro
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Paolucci
- Headache Centre, Neurology Unit, University Campus Bio-Medico, Rome, Italy
| | - T J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - M Ulivi
- Headache Centre, Neurology Unit, University Campus Bio-Medico, Rome, Italy
| | - S Cevoli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - S Guerzoni
- Medical Toxicology - Headache Centre, Policlinic Hospital, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
19
|
Negro A, Curto M, Lionetto L, Guerzoni S, Pini LA, Martelletti P. A Critical Evaluation on MOH Current Treatments. Curr Treat Options Neurol 2017; 19:32. [PMID: 28808924 DOI: 10.1007/s11940-017-0465-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Migraine is the most frequent neurological disorder observed in clinical practice characterized by moderate to severe pain attacks associated with neurological, gastrointestinal, and dysautonomic symptoms. Each year, 2.5% of patients with episodic migraine develop chronic migraine (CM). CM is characterized by high frequency of the attacks that may result into chronic intake of abortive medications. Nearly, the 70% of CM patients referring to tertiary head centers show acute pain medications overuse that may lead to the development of medication overuse headache (MOH). The management of MOH requires three steps: (1) education, (2) withdrawal of the overuse drug and detoxification, and (3) re-prophylaxis. In the last years, several real-life prospective studies provided further evidence in clinical setting of the onabotulinumtoxinA 155-195 U efficacy for the headache prophylaxis in CM with MOH patients. There is a general agreement on two factors: (1) withdrawal of the overuse drug is condicio sine qua non to reverse the pattern to medium-low-frequency migraine, and (2) the focus of management needs to shift from acute treatment of pain to prevention of headache. CM patients close to developing MOH, patients with high-frequency episodic migraine, and those already abusing of drugs require special attention and should refer to tertiary headache centers. For all of them, a solution could be an "early treatment." Early should be their referral to a tertiary headache center, early should be the withdrawal of the overuse drug and a proper detoxification, and perhaps early should be the start of a preventative therapy.
Collapse
Affiliation(s)
- Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy. .,Regional Referral Headache Centre, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00191, Rome, Italy.
| | - Martina Curto
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI Istituto Dermopatico dell'Immacolata - IRCSS, Rome, Italy
| | - Simona Guerzoni
- Department of Diagnostic and Clinical Medicine and Public Health, Proteomic Lab, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Alberto Pini
- Department of Diagnostic and Clinical Medicine and Public Health, Proteomic Lab, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00191, Rome, Italy
| |
Collapse
|