Abstract
Objectives A growing number of headache clinics exist in Australia for specialist management of complex headache disorders. Previous international data have shown that before specialist review there is low use of headache preventative treatments and high rates of analgesic medication overuse. This study aims to characterize the patients seen in an Australian headache clinic, with particular emphasis on these two issues.
Methods A retrospective analysis of all patients seen at a tertiary hospital headache clinic was completed over a four-and-a-half-year period. Data were collected from electronic medical record notes. The details recorded include patient demographics, final headache diagnosis, presence of medication overuse, previous preventer medication use, and brain imaging performed.
Results 425 sequential patients were reviewed from July 2017 to December 2021. 80% were female with median age of 44 years. 35% had not received a formal diagnosis prior to clinic other than ‘headache’. The final clinic diagnosis by ICHD-3b criteria was a class 1 headache (migraine) in 91%. Medication overuse was present in 46% – most commonly with multiple analgesics (20%) or simple analgesia (18%). 41% had not trialled any preventer medication before the clinic, and 14% more had inadequate preventer trials (defined as less than 3 months use or inadequate dosage of a single appropriate medication). 91% had brain imaging pre-clinic with incidental findings in 34%.
Conclusions Significant potential exists to improve primary care headache treatment in Australia. Increased knowledge of medication overuse and first line preventer medications would be the first steps towards this.
