When it comes to managing chronic headache, a practical coordinated approach aimed at filling the gaps in usual care leads to a marked improvement in patients' quality of life and satisfaction with treatment. Chronic headache (primarily migraine and tension-type headache) is the cause of significant illness and disability that is frequently not well managed in general clinical practice. Researchers from North Carolina examined 614 patients with chronic headache to determine whether a coordinated headache management programme would reduce headache disability compared to usual care. The programme included an educational class to teach patients about headache types, triggers and treatment options; diagnosis and treatment by a professional with expertise in headache care; and proactive follow-up by a case manager for 6 months. Patients randomised to the control group received usual care from their primary care providers. It was found that, after 6 months, the level of headache-related disability was reduced significantly more in patients who participated in the coordinated headache programme than in patients receiving usual headache care and there was a trend toward persistent benefit at 12 months. Improvements in general health, quality of life, and satisfaction with headache treatment were greater in the coordinated intervention group. Coordinated headache management improves the outcome for many patients and this trial could be implemented practically in a wide range of settings with meaningful improvements for patients.
Headache
October 2008