Coordinated headache management best

NEW YORK (Reuters Health) - 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, researchers report in the journal Headache.

Chronic headache -- primarily migraine and tension-type headache -- is the cause of significant illness and cost, Dr. David B. Matchar, of Duke University Medical Center, Durham, North Carolina, and colleagues note in their report.

While a wide range of effective drug and non-drug therapies are available to prevent and treat headaches, "current treatment of chronic headache is frequently suboptimal," they note.

In a randomized controlled study involving 614 chronic headache sufferers, the researchers examined whether a coordinated headache management program would reduce headache disability compared to usual care.

The program 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 randomized to the control group received usual care from their primary care providers.

At 6 months, the level of headache-related disability was reduced significantly more in patients who participated in the coordinated headache program 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 intervention group.

"While a few, highly specialized, intensive headache clinics for very severely affected headache patients are well-established, general headache disease management programs are not commonly available for the broad population whose headache disability may be overlooked or under treated," Matchar and colleagues comment.

"For these patients, who need and deserve better care, the intervention in this trial could be implemented practically in a wide range of settings with the expectation that meaningful improvements will accrue," they conclude.

SOURCE: Headache, October 2008.