A Survey on Probable and Improbable Decisions About Headache Treatment
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MEDICINE
A Survey on Probable and Improbable Decisions About Headache Treatment Heiko Pohl 1
&
Andreas R. Gantenbein 1,2 & Peter S. Sandor 1,2 & Colette Andrée 3,4
Accepted: 24 September 2020 # The Author(s) 2020
Abstract The treatment of headache disorders is adapted to their severity. It is the aim of this study to evaluate the probability of treatment decisions being taken and to identify underlying principles influencing them. The study was internet-based and cross-sectional; participants completed the EUROLIGHT questionnaire anonymously. Inclusion criterion was the consent to participate. Participants were excluded if diagnostic questions had not been completed. We estimated probabilities based on relative frequencies and built binary logistic regression models to identify factors influencing decision-making. The survey was completed by 976 individuals; 636 completed the diagnostic questions. The probability of a patient to consult a GP or a neurologist was 0.26 and 0.20, respectively. Patients decided by a probability of 0.93 to take acute treatment. These treatment decisions, which were taken by patients alone increased in probability with increasing ictal burden (P < 0.001, P < 0.001 and P < 0.001). The probability of treating migraine with triptans was 0.74; the probability to take a prophylactic treatment was 0.43. Neurologists were more likely than GPs to prescribe these medications (P = 0.006 and P < 0.001, respectively). We identified several principles underlying treatment decisions. Most patients decide to take acute treatment for headache attacks; they are less likely to treat their headache disorder interictally. Treatment decisions are less likely to be taken if more than one decision-maker is involved; if physicians are involved, severity of the headache disorder does not affect the probability of a treatment decision being taken. Overall, the more severely affected a headache patient, the less likely an adequate treatment. Keywords Therapeutic decisions . Migraine . Tension-type headache . Headache treatment
Abbreviations BLR Binary logistic regression CI Confidence interval GP General practitioner HADS Hospital Anxiety and Depression Scale n.r. Not reported NSAID Non-steroidal anti-inflammatory drug OTC Over-the-counter TTH Tension-type headache * Heiko Pohl [email protected] 1
Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
2
RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
3
Migraine Action Switzerland, Bottmingen, Switzerland
4
Department of Pharmaceutical Sciences, University Basel, Basel, Switzerland
Introduction Headache disorders affect patients’ lives to varying extent. While some suffer only occasional attacks hardly affecting their everyday lives, others find their well-being curtailed [20]. Guidelines consequently advise tailoring treatment regimens to individual needs [3, 5, 16, 17]. Finding an adequate therapy is not straightforward. Of several available remedies, patients and physicians choose by trial and error.
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