Background
Methods
Study design
Instrument
Headache diagnosis
Medical consultation
Statistical analyses
Results
Medical consultation
Headache type | Medical consultation | |||||
---|---|---|---|---|---|---|
N | Pharmacist | Paramedic | Physician | Specialist | Overall | |
n (%) [95% confidence interval] | ||||||
Tension-type headache | 863 | 123 (14.3) [12.0–16.8] | 185 (21.4) [18.7–24.3] | 64 (7.4) [5.8–9.4] | 47 (5.4) [4.0–7.2] | 419 (48.6) [45.2–51.9] |
Migraine | 728 | 117 (16.1) [13.5–18.9] | 216 (29.7) [26.4–33.1] | 101 (13.9) [11.4–16.6] | 55 (7.6) [5.7–9.7] | 489 (67.2) [63.6–70.6] |
Probable medication-overuse headache | 46 | 9 (19.6) [9.4–33.9] | 10 (21.7) [10.9–36.4] | 11 (23.9) [12.6–38.8] | 10 (21.7) [10.9–36.4] | 40 (87.0) [73.7–95.6] |
p* | – | < 0.001 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Investigations and treatments
All | Habitation | Dwelling altitude | |||||
---|---|---|---|---|---|---|---|
Urban | Rural | p* | < 1000 m | ≥1000 m | p* | ||
n (%) [95% CI] | n (%) [95% CI] | ||||||
Investigations in the preceding year | |||||||
All | 214 (11.9) [10.5–13.5] | 75 (10.9) [8.7–13.5] | 139 (12.5) [10.7–14.6] | 0.33 | 106 (12.5) [10.4–15.0] | 108 (11.4) [9.4–13.6] | 0.47 |
Xray of paranasal sinuses | 26 (1.4) [0.9–2.1] | 5 (0.7) [0.2–1.7] | 21 (1.9) [1.2–2.9] | 0.07 | 12 (1.4) [0.7–2.5] | 14 (1.5) [0.8–2.5] | 0.99 |
Xray of neck | 7 (0.4) [0.2–0.6] | 3 (0.4) [0.1–1.3] | 4 (0.4) [0.1–0.9] | 1.0 | 1 (0.1) [0.0–0.7] | 6 (0.6) [0.2–1.4] | 0.13 |
Brain imaging (CT or MRI) | 16 (0.9) [0.5–0.9] | 7 (1.0) [0.4–2.1] | 9 (0.8) [0.4–1.5] | 0.79 | 9 (1.1) [0.5–2.0] | 7 (0.7) [0.3–1.5] | 0.61 |
EEG | 5 (0.3) [0.1–0.5] | 1 (0.1) [0.0–0.8] | 4 (0.4) [0.1–0.9] | 0.65 | 0 (0.0) - | 5 (0.5) [0.2–1.2] | – |
Eye test | 160 (8.9) [7.6–10.3] | 59 (8.6) [6.6–11.0] | 101 (9.1) [7.5–11.0] | 0.73 | 82 (9.7) [7.8–11.9] | 78 (8.2) [6.6–10.2] | 0.28 |
Conventional medications in the preceding month | |||||||
Overall | 912 (50.8) [48.5–53.2] | 299 (43.6) [39.8–47.4] | 613 (55.3) [52.3–58.3] |
< 0.001
| 393 (46.5) [43.1–49.9] | 519 (54.7) [51.5–57.9] |
< 0.001
|
Paracetamol | 682 (38.0) [35.8–40.3] | 203 (29.6) [26.2–33.2] | 479 (43.2) [41.9–47.8] |
< 0.001
| 250 (29.6) [26.5–32.8] | 432 (45.5) [42.3–48.8] |
< 0.001
|
Ibuprofen | 150 (8.4) [7.1–9.7] | 57 (8.3) [6.4–10.6] | 93 (8.4) [6.8–10.2] | 0.99 | 51 (5.9) [4.5–7.9] | 99 (10.4) [8.6–12.6] |
0.001
|
Nimesulide | 94 (5.2) [4.3–6.4] | 49 (7.1) [5.3–9.3] | 45 (4.1) [3.0–5.4] |
0.009
| 68 (8.0) [6.3–10.1] | 26 (2.7) [1.8–4.0] |
< 0.001
|
NSAID/paracetamol combination | 71 (4.0) [3.1–5.0] | 18 (2.6) [1.6–4.1] | 53 (4.8) [3.6–6.2] |
0.025
| 43 (5.1) [3.7–6.8] | 28 (3.0) [2.0–4.1] |
0.021
|
Herbal therapies in the preceding month | |||||||
Overall | 185 (10.3) [8.9–11.8] | 36 (5.2) [3.7–7.2] | 149 (13.4) [11.5–15.6] |
< 0.001
| 63 (7.5) [5.8–9.4] | 122 (12.9) [10.8–15.2] |
< 0.001
|
Vicks | 64 (3.6) [2.8–4.6] | 15 (2.2) [1.2–3.6] | 49 (4.4) [3.3–5.8] |
0.013
| 36 (4.3) [3.0–5.8] | 28 (3.0) [3.0–4.3] | 0.16 |
Tulsi leaves | 11 (0.6) [0.3–1.1] | 3 (0.4) [0.1–1.3] | 8 (0.7) (0.3–1.4) | 0.55 | 7 (0.8) [0.3–1.7] | 4 (0.4) [0.1–1.1] | 0.37 |
Titepati leaves | 11 (0.6) [0.3–1.1] | 3 (0.4) [0.1–1.3] | 8 (0.7) [0.3–1.4] | 0.55 | 2 (0.2) [0.0–0.9] | 9 (0.9) [0.4–1.8] | 0.069 |
Associations
Variable | N | Overall | Specialist | ||
---|---|---|---|---|---|
n (%) | 95% CI | n (%) | 95% CI | ||
Age (years) | |||||
18–25 | 426 | 240 (56.3) | 51.5–61.1 | 24 (5.6) | 3.6–8.3 |
26–35 | 581 | 346 (59.6) | 55.4–63.6 | 54 (9.3) | 7.1–12.0 |
36–45 | 358 | 204 (57.0) | 51.7–62.2 | 25 (7.0) | 4.6–10.1 |
46–55 | 258 | 162 (62.9) | 56.6–68.7 | 18 (7.0) | 4.2–10.8 |
56–65 | 171 | 96 (56.1) | 48.4–63.7 | 15 (8.8) | 5.0–14.1 |
Gender | |||||
Male | 689 | 384 (55.7) | 51.9–59.5 | 42 (6.1) | 4.4–8.2 |
Female | 1105 | 664 (60.1) | 57.1–63.0 | 94 (8.5) | 6.9–10.3 |
Household consumption (USD/year) | |||||
< 950 | 686 | 423 (61.7) | 57.9–65.3 | 46 (6.7) | 5.0–8.8 |
950–1200 | 687 | 400 (58.2) | 54.4–61.9 | 61 (8.9) | 6.9–11.3 |
> 1200 | 421 | 225 (53.4) | 48.6–58.3 | 29 (6.9) | 4.7–9.7 |
Habitation | |||||
Urban | 686 | 354 (51.6) | 47.8–55.4 | 54 (7.9) | 6.0–10.1 |
Rural | 1108 | 694 (62.6) | 59.7–65.5 | 82 (7.4) | 5.9–9.1 |
Dwelling altitude (m) | |||||
< 1000 | 845 | 474 (56.1) | 52.7–59.5 | 72 (8.5) | 6.7–10.6 |
≥ 1000 | 949 | 574 (60.5) | 57.3–63.6 | 64 (6.7) | 5.2–8.5 |
Variable | Overall | Specialist consultation | ||||||
---|---|---|---|---|---|---|---|---|
Bivariate analysis | Multivariate analysis | Bivariate analysis | Multivariate analysis | |||||
OR (95% CI) | p | AOR a (95% CI) | p | OR (95% CI) | p | AOR a (95% CI) | p | |
Age (in years) | ||||||||
18–25 | Reference | – | Reference | – | Reference | – | Reference | – |
26–35 | 1.1 (0.9–1.5) | 0.31 | 1.1 (0.8–1.4) | 0.54 | 1.7 (1.1–2.8) |
0.034
| 1.5 (0.9–2.5) | 0.11 |
36–45 | 1.0 (0.8–1.4) | 0.86 | 0.9 (0.7–1.3) | 0.62 | 1.3 (0.7–2.4) | 0.44 | 1.2 (0.6–2.1) | 0.65 |
46–55 | 1.3 (0.6–1.8) | 0.10 | 1.2 (0.9–1.7) | 0.28 | 1.3 (0.7–2.4) | 0.48 | 1.1 (0.6–2.2) | 0.71 |
56–65 | 1.0 (0.7–1.5) | 0.96 | 0.8 (0.6–1.2) | 0.28 | 1.6 (0.8–3.2) | 0.16 | 1.5 (0.8–3.0) | 0.24 |
Gender | ||||||||
Male | Reference | – | Reference | – | Reference | – | Reference | – |
Female | 1.2 (0.9–1.5) | 0.069 | 1.0 (0.8–1.2) | 0.96 | 1.4 (1.0–2.1) | 0.062 | 1.2 (0.8–1.8) | 0.28 |
Household consumption (USD/year) | ||||||||
< 950 | 1.2 (0.9–1.4) | 0.19 | 1.1 (0.9–1.4) | 0.40 | 0.7 (0.5–1.1) | 0.13 | 0.8 (0.5–1.1) | 0.17 |
950–1200 | Reference | – | Reference | – | Reference | – | Reference | – |
> 1200 | 0.8 (0.6–1.1) | 0.12 | 0.8 (0.6–1.0) | 0.11 | 0.8 (0.5–1.2) | 0.24 | 0.7 (0.5–1.2) | 0.20 |
Habitation | ||||||||
Urban | Reference | – | Reference | – | Reference | – | Reference | – |
Rural | 1.6 (1.3–1.9) |
< 0.001
| 1.5 (1.2–1.9) |
< 0.001
| 0.9 (0.7–1.3) | 0.71 | 0.9 (0.6–1.3) | 0.51 |
Dwelling altitude(m) | ||||||||
< 1000 | Reference | – | Reference | – | Reference | – | Reference | – |
≥ 1000 | 1.2 (0.9–1.4) | 0.06 | 1.0 (0.8–1.2) | 0.96 | 0.8 (0.6–1.1) | 0.16 | 0.7 (0.5–1.1) | 0.094 |
Index | Overall | Specialist consultation | ||||||
---|---|---|---|---|---|---|---|---|
Bivariate analysis | Multivariate analysis | Bivariate analysis | Multivariate analysis | |||||
OR (95% CI) | p | AOR a (95% CI) | p | OR (95% CI) | p | AOR a (95% CI) | p | |
Headache frequency (d/m) | ||||||||
< 1 | Reference | – | Reference | – | Reference | – | Reference | – |
1–2 | 1.2 (0.9–1.5) | 0.18 | 1.2 (0.9–1.5) | 0.17 | 0.6 (0.4–0.9) |
0.025
| 0.6 (0.4–0.9) |
0.023
|
3–14 | 1.8 (1.4–2.3) |
< 0.001
| 1.9 (1.5–2.4) |
< 0.001
| 0.7 (0.4–1.1) | 0.14 | 0.7 (0.4–1.1) | 0.12 |
≥ 15 | 2.7 (1.8–3.9) |
< 0.001
| 2.6 (1.8–3.9) |
< 0.001
| 2.2 (1.3–3.6) |
0.002
| 2.1 (1.3–3.5) |
0.004
|
Attack duration (hours) | ||||||||
< 4 | Reference | – | Reference | – | Reference | – | Reference | – |
4–12 | 2.0 (1.6–2.6) |
< 0.001
| 2.1 (1.6–2.6) |
< 0.001
| 1.5 (0.9–2.3) | 0.13 | 1.4 (0.9–2.3) | 0.14 |
> 12 | 3.1 (2.5–4.3) |
< 0.001
| 3.3 (2.3–4.1) |
< 0.001
| 1.5 (0.9–2.2) | 0.087 | 1.4 (0.9–2.4) | 0.10 |
Headache intensity | ||||||||
Mild | Reference | – | Reference | – | Reference | – | Reference | – |
Moderate | 2.5 (2.0–3.2) |
< 0.001
| 2.5 (2.0–3.2) |
< 0.001
| 1.3 (0.8–2.3) | 0.30 | 1.3 (0.8–2.3) | 0.31 |
Severe | 3.8 (2.9–5.1) |
< 0.001
| 3.6 (2.7–4.8) |
< 0.001
| 2.6 (1.5–4.5) |
0.001
| 2.7 (1.3–4.7) |
< 0.001
|
Proportion of time in ictal state (pT) (%) | ||||||||
< 1 | Reference | – | Reference | – | Reference | – | Reference | – |
1–2 | 1.5 (1.1–2.0) |
0.012
| 1.5 (1.1–2.0) |
0.014
| 1.0 (0.6–1.7) | 0.92 | 1.0 (0.5–1.7) | 0.95 |
2.1–8 | 1.6 (1.2–2.1) |
0.001
| 1.6 (1.2–2.1) |
0.001
| 0.5 (0.2–0.9) |
0.023
| 0.5 (0.3–0.9) |
0.021
|
> 8 | 2.8 (2.2–3.5) |
< 0.001
| 2.9 (2.3–3.7) |
< 0.001
| 1.4 (0.9–2.1) | 0.094 | 1.4 (0.9–2.0) | 0.13 |