Pattern of headache among patients attending at Muhimbili National Hospital neurology clinic-2012

Abstract

Introduction: Headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. Headache disorders are among the most common disorders of the nervous system which is associated with personal and societal burdens of pain, disability, damaged quality of life and financial cost. It is one of the most common types of recurrent pain as well as one of the most frequent symptoms in neurology. Similar study was done in the same clinic more than twenty years ago ,However a previous study described the pattern of headache using HIS criteria and there is no new study that is known to use the new diagnostic criteria since then. Also with recent advancements in technology together with the development of disease like HIV/AIDS lead to the development of new etiology of headache and epidemiological transition of diseases. Objective: To establish the pattern of headache among patients in Neurology clinic at Muhimbili National Hospital (MNH). This was a Hospital based descriptive cross sectional study among outpatients at neurology clinic at MNH. A total of 278 patients with headache were consecutively recruited from May to December 2012. A structured questionnaire was used to collect data on demographics and symptoms of headache. International classification for headache disorder volume II (ICHD-II) was used to categorize different types of headaches. Data was entered and analyzed by using SPSS version 10. Chi-square test was used to determine the association between the different predisposing factors and different types of headache. Student t test was used to compare means of two variables. P-value of <0.05 or less was taken as significant Results: During the 8 months period, a total of 1440 patients attended the MNH Neurology clinic. Of these 278/1440 (19.31%) had recurrent Headache. Females were 179/278 (64.38%).Primary headache was seen in151/278 (54%) patients, of these 103/151 (37%) suffered migraine. No significant difference in gender among migraine, Cluster headache (CH) and Tensional type headache (TTH)patients. Patients aged 60 years and above who were attended suffered from Migraine were 7/11(63.3%). Anxiety 40 (37.7 %), Smoking cigarette 9(37.5%) and Depression 25 (30.1 %) were the major precipitants of Migraine type headache, Tensional type headache was associated with cigarette smoking (33.3%) and Oral contraceptive use 25.0 %. Thirty nine patients came at neurology clinic without the referral diagnosis of headache of which 24 (61.5%) of the patient were classified as having migraine headache. Conclusions and Recommendations The pattern of headache was dominated by primary headache, similar to the findings of the study done 20 years ago at the same clinic. Primary headache especially migraine was common in patients 60 years of age or older. Primary headache types were highly associated with anxiety and depression. The referral bias observed in most of the results findings necessitates the need for further studies to evaluate similar pattern in a non-specialized hospital.