Thomas E, Boardman H F, Ogden H, Millson D S, Croft P R
Primary Care Sciences Research Centre, Keele University, Keele, UK.
Cephalalgia. 2004 Sep;24(9):740-52. doi: 10.1111/j.1468-2982.2004.00751.x.
Using data from a cross-sectional survey and a prospective record linkage study the aims of this study were to: (i) determine sources of advice and care for headaches in a population survey of adults, and (ii) investigate prospectively the influences of headaches on general practice consultation in a 12-month follow-up of the responders to the population survey. A population based cross-sectional survey was mailed to 4885 adults (aged > or = 18 years) with an adjusted response rate of 56% (n = 2662). The main outcome measures of interest were (i) self-report advice and care-seeking in the survey (ii) consultation with general practitioner for headache and for other conditions in 12-month period subsequent to the survey. Reporting a recent GP consultation for headache was associated with younger age (mean: 46 vs 48 years), female gender (68% vs 60%), and greater headache severity as measured by frequency, pain, and associated disability. The commonest sources of advice and care in the past were GPs (27%), opticians (21%), and pharmacists (8%). Consultations for headache were not common in the 12-months following the survey (n = 144); however, those reporting a recent headache were almost 4 times more likely to consult subsequently with a headache than those not (relative risk; 95% CI: 3.7; 1.9, 7.0). Recent reporting of headache was also associated with an increased risk of consulting for mental disorders (1.7; 1.2, 2.6), diseases of the digestive (1.6; 1.1, 2.3) and respiratory system (1.4; 1.1, 1.8), and a decreased risk of consulting for circulatory diseases (0.8; 0.7, 1.0). Only a minority of headache sufferers consult their GP, regardless of severity, with opticians and pharmacists being other important sources of information. Headache appears to have an additional impact upon GP workload through increased rates of consultations for nonheadache conditions amongst headache sufferers. The interesting findings regarding rates of consultation for digestive and circulatory conditions amongst headache sufferers may be linked to the use of headache medication.
利用横断面调查和前瞻性记录链接研究的数据，本研究的目的是：（i）在一项成人人口调查中确定头痛的建议和护理来源，以及（ii）在对人口调查的应答者进行12个月的随访中，前瞻性地调查头痛对全科医疗咨询的影响。一项基于人群的横断面调查被邮寄给4885名成年人（年龄≥18岁），调整后的应答率为56%（n = 2662）。感兴趣的主要结局指标为：（i）调查中的自我报告建议和寻求护理情况，（ii）在调查后的12个月内因头痛和其他疾病向全科医生咨询的情况。报告近期因头痛向全科医生咨询与较年轻的年龄（平均：46岁对48岁）、女性性别（68%对60%）以及通过频率、疼痛和相关残疾衡量的更严重头痛有关。过去最常见的建议和护理来源是全科医生（27%）、验光师（21%）和药剂师（8%）。在调查后的12个月内，因头痛进行的咨询并不常见（n = 144）；然而，报告近期头痛的人随后因头痛咨询的可能性几乎是未报告者的4倍（相对风险；95%置信区间：3.7；1.9，7.0）。近期报告头痛还与因精神障碍咨询的风险增加（1.7；1.2，2.6）、消化系统疾病（1.6；1.1，2.3）和呼吸系统疾病（1.4；1.1，1.8）有关，以及因循环系统疾病咨询的风险降低（0.8；0.7，1.0）。无论头痛严重程度如何，只有少数头痛患者会咨询他们的全科医生，验光师和药剂师是其他重要的信息来源。头痛似乎通过头痛患者中非头痛疾病咨询率的增加对全科医生的工作量产生额外影响。关于头痛患者中消化系统和循环系统疾病咨询率的有趣发现可能与头痛药物的使用有关。
