Description of patterns of chronic headache among patients attending Mulago hospital neurology clinic.
Abstract
Description
A thesis submitted in partial fulfillment of the requirements for the award of the Masters of Medicine in Internal Medicine Degree of Makerere University.
Background: Headache is a cause of disability affecting all populations and among the common complaints prompting referral of patients to physicians for assessment. Primary care Physicians often misdiagnose and hence poorly treat headaches especially the Primary headaches. Patients themselves do not consult their Physicians preferring to use over-the counter less effective drugs. This in turn leads to poor quality of life, absence from work as well as poor school performance and can lead to drug dependence. There is no published literature and research on the problem of headache in Uganda. This study was done to shed light on the patterns of chronic headache and offer clinicians clues to correct diagnosis and better management of their patients. Objectives: To describe the patterns of chronic headache and factors associated with secondary chronic headaches among patients attending Mulago Hospital Neurology clinic. Methodology: Study setting: Neurology clinic, New Mulago Hospital. Design: Descriptive cross-sectional study. Subjects: Patients aged 12 years and above with chronic headache. Measurements: Patients were recruited from the Neurology clinic consecutively until sample size was attained. A face to face interview using a standardized questionnaire adapted from Fishbain et al, 2001, on symptoms related to chronic headache was administered and a physical examination with emphasis on the neurological examination performed. The Hamilton Depression and Anxiety scale was used to screen for psychiatric illness. A CBC and ESR, B/S for MPs, HIV test was done for each patient. The IHS classification was then used to categorize the various headaches. Study results: Females were the majority of patients, making up 6 1.9%. Migraine headache was the commonest making up 85.7% of all the diagnoses, followed by tension headache with 30.2% and cervicogenic with 20.5%. Other diagnoses included cluster headache, which was the least represented among the primary headache group, sinusitis, hypertension, depression and post traumatic headache. About 50% of the patients had more than one headache diagnosis. The greatest percentage overlap was between migraine and tension headache followed by migraine and cervicogenic headache. Female to male ratios in most of the MS classifications were higher except for cluster headache, which had only males. The most frequent headache precipitant and aggravating factor was bright light for migraine and tension headache and moving the neck for cervicogenic. Six (9.5%) of the patients had a positive HIV test. Conclusions and recommendations The results in this study show that the females are more commonly affected by chronic headache than males; migraine is the commonest chronic headache in Mulago Hospital Neurology clinic. Primary headaches were more common than secondary headaches. About half of the patients had more than one headache diagnosis and the commonest secondary headache was cervicogenic. History taking is often enough to come up with a diagnosis especially for primary headaches. Physicians should attempt to elicit symptoms in these headache patients in order to diagnose and treat headache patients appropriately. This could be done by simplifying the Fishbain et al questionnaire. Clinicians should also make use of the HIS classification for correct diagnosis.
Background: Headache is a cause of disability affecting all populations and among the common complaints prompting referral of patients to physicians for assessment. Primary care Physicians often misdiagnose and hence poorly treat headaches especially the Primary headaches. Patients themselves do not consult their Physicians preferring to use over-the counter less effective drugs. This in turn leads to poor quality of life, absence from work as well as poor school performance and can lead to drug dependence. There is no published literature and research on the problem of headache in Uganda. This study was done to shed light on the patterns of chronic headache and offer clinicians clues to correct diagnosis and better management of their patients. Objectives: To describe the patterns of chronic headache and factors associated with secondary chronic headaches among patients attending Mulago Hospital Neurology clinic. Methodology: Study setting: Neurology clinic, New Mulago Hospital. Design: Descriptive cross-sectional study. Subjects: Patients aged 12 years and above with chronic headache. Measurements: Patients were recruited from the Neurology clinic consecutively until sample size was attained. A face to face interview using a standardized questionnaire adapted from Fishbain et al, 2001, on symptoms related to chronic headache was administered and a physical examination with emphasis on the neurological examination performed. The Hamilton Depression and Anxiety scale was used to screen for psychiatric illness. A CBC and ESR, B/S for MPs, HIV test was done for each patient. The IHS classification was then used to categorize the various headaches. Study results: Females were the majority of patients, making up 6 1.9%. Migraine headache was the commonest making up 85.7% of all the diagnoses, followed by tension headache with 30.2% and cervicogenic with 20.5%. Other diagnoses included cluster headache, which was the least represented among the primary headache group, sinusitis, hypertension, depression and post traumatic headache. About 50% of the patients had more than one headache diagnosis. The greatest percentage overlap was between migraine and tension headache followed by migraine and cervicogenic headache. Female to male ratios in most of the MS classifications were higher except for cluster headache, which had only males. The most frequent headache precipitant and aggravating factor was bright light for migraine and tension headache and moving the neck for cervicogenic. Six (9.5%) of the patients had a positive HIV test. Conclusions and recommendations The results in this study show that the females are more commonly affected by chronic headache than males; migraine is the commonest chronic headache in Mulago Hospital Neurology clinic. Primary headaches were more common than secondary headaches. About half of the patients had more than one headache diagnosis and the commonest secondary headache was cervicogenic. History taking is often enough to come up with a diagnosis especially for primary headaches. Physicians should attempt to elicit symptoms in these headache patients in order to diagnose and treat headache patients appropriately. This could be done by simplifying the Fishbain et al questionnaire. Clinicians should also make use of the HIS classification for correct diagnosis.
Keywords
Description, Chronic headache, Patients, Mulago hospital, Neurology clinic, Primary care, HIV/AIDS