Epidemiological Studies and Headaches
Matuja WB, Mteza IB, Rwiza HT, Headache in a nonclinical population in Dar es
Salaam, Tanzania. A community-based study Headache, 1995 05, 35: 5, 273-6
Headache is a common symptom that constitutes a major health problem to all
countries in the world with a variable prevalence from about 20.2% in the
African population to about 80% in populations of the civilized world.
Community-based studies in African populations are still scanty, and the
impact on health facility utilization and sickness absence from work is
unknown. After a simple random selection, 1540 urban workers and students of
higher education completed a standardized self-administered questionnaire on
headache. A total of 815 (52%), (620 (51%) men, 195 (60%) women) admitted to
having suffered a headache requiring medication or medical consultation in
the last year. Of these, 366 (23.7%) had recurrent headache not attributable
to systemic disease. Of the total with recurrent headache, there was a sig
nificant preponderance of women over men with sex prevalence of 28.9% and
22.4%, respectively (X2 P = 0.0001). Combined vascular-muscular-type of
headache exceeded all types of headache, accounting for 35.8% of cases,
followed by migraine accounting for 30.8% of cases. Organic disease was rare,
accounting for 8.5% of cases, and psychogenic causes of headache were even
rarer at less than 1.2% of cases. Within 2 months of onset of recurrent
headaches, over 32% of sufferers had utilized the health facility at their
place of work or study. A significant number of cases (175) had an average of
11.3 lost work days per year in comparison to a control group of 154 persons
with an average of 5.7 lost work days per year for reasons other than headache
Solomon S; Lipton RB, A headache clinic-based approach to field trials of the
International Headache Society criteria. Cephalalgia, 1993 04, 13 Suppl 12:
, 63-5
Criteria for the diagnosis of headache disorders have recently been developed
but require empirical validation. We present an approach to the evaluation of
headache criteria in a headache clinic: define the group of headache
sufferers to be studied, obtain data used in establishing the diagnosis,
apply the diagnostic criteria and assess their usefulness. In applying this
method to a group of patients with chronic daily headache, we found that
approximately one-third would not fit the current criteria for chronic
tension-type headache. We conclude that empiric validation of headache
criteria based on subjective data is a complex and iterative process.
Operational criteria for headache diagnosis to be used by primary care
physicians should be validated in that setting and ideally should be
relatively simple.
Stewart WF, Lipton RB, Migraine headache: epidemiology and health care
utilization Cephalalgia, 1993 04, 13 Suppl 12: 41-6
Population-based studies of headache can help inform the development of
diagnostic criteria. In population-based studies, migraine has been
consistently revealed as a common disabling condition that affects males and
females of all ages. From data obtained in a national survey of the United
States population, we show that the prevalence of migraine and the frequency
of attacks increase as household income decreases. Disability from attacks is
not related to income. In contrast, physician diagnosis is more likely as
household income increases. Moreover, physician diagnosis is more likely
among females, older cases, those more likely to experience disability, and
migraine sufferers reporting nausea (males), vomiting, and visual and sensory
aura. Analysis of our data leads us to conclude that the symptoms most
strongly associated with diagnosis may provide the greatest concern and inter
est on the part of physicians to make a diagnosis, even though other
migraine-related symptoms are more common in the population and in clinical
settings. Finally, among migraine sufferers with severe disability, a very
large proportion do not receive the benefits of medical diagnosis and
treatment. Though most migraine sufferers use OTC medications, given the
frequency and associated disability of their migraine attacks, current
therapy appears unsatisfactory.
Ebrall P, A Descriptive Report of the Case-Mix Within Australian
Chiropractic Practice, 1992 Chiropractic Journal of Australia 1993 Sep;
23(3) : 9 2-7
The objective of this study was to generate a description of the of
chiropractic in Australia by using a prospective recording instrument
provided to volunteer chiropractors. The 25 respondents were located in
private practice throughout six of the eight jurisdictions in Australia. They
were members of the Chiropractor's Association of Australia and recorded
details of 100 consecutive patient visits from Monday, 7 September 1992. A
total of 2,500 patient visits were recorded. Of these, 1148 (46%) were made
by males and 1352 (54%) by females. There were 246 (9.8%) new patient visits
and 2254 (90.2%) return patient visits. The mean age of the patients was
39.45 years, and half of the patient visits were generated by patients in the
age range of 30 to 50 years. The presenting complaint was back pain in 41% of
patient visits, neck pain in 23%, and headache in 14%. There were 85 (3.4%)
patient visits at which an apparently non-musculoskeletal presenting
complaint was reported. Patients with workers' compensation accounted for
less than 10% of all visits. Slightly over half of all visits were funded by
a private health fund, with the highest percentage being in South Australia
(76.8%) and Western Australia (74.3%), falling to 25% in the ACT. This study
is an early attempt to define the case-mix of Australian chiropractic
practice, and concludes that chiropractors mostly treat musculoskeletal
complaints where the patient is reimbursed for the cost of treatment by a
third party. The proportion of non-musculoskeletal diagnoses, while very
small, can be seen as demanding the retention of differential diagnostic
skills by chiropractors, even though the number of patients with a primary
presenting complaint of a visceral nature is extremely small.
Wight J, Migraine: a statistical analysis of chiropractic treatment ACA
Journal of Chiropractic 1978 Sep; 15(9): S63-7
A group of 87 patients with common or classical migraine were treated
chiropractic adjustment of involved vertebral segments and the results
analyzed two years after the final treatment by means of a headache
questionnaire. Of the patients with common migraine, 85% of females and 50%
of males were either improved or their headaches ceased altogether, while
patients with classical migraine showed an improvement rate of 78% for
females and 75% for males. Comparing the improvement rates for female and
male patients and comparison of the improvement rates in the common and
classical groups were found not to be statistically different in either
study. The total reduction in frequency of headaches following treatment is
also discussed.
Chiropractic and Headache Related Literature