Effectiveness of the telephonic-case-management for treatment of headache. A pilot study.

Chronic or intermittent headache affects the patients' quality of life, and has direct and indirect social costs. Several chronic illnesses are already treated through telephone counseling, however there is poor evidence in literature about headache treatment via telenursing, and it is not clear which role could the nurse play in this specific field. The study was carried out at the headache centre of "G. D'Annunzio" University - Chieti, and involved 62 patients, half of them were assigned to receive specialized telenursing in addiction to the standard care bean. During the 13 weeks of follow up the headache characteristics were regularly assessed (frequency and intensity). Pain assessment was performed using the VAS, and quality of life was assessed at baseline and at the end of the follow up using the SF-12 standard V1 questionnaire. The differences between the two groups are statistically significant during the last 5 week of follow up, (8th -12th; 0.002<p<0.03). Patients in the experimental group show a better compliance to the therapeutic plan (p < 0.5), report a better quality of life (p < 0.5), and had lesser contacts with the GP or the casualty clinic. The headache frequency did not differ between the two groups, but the patients in the experimental group reported a lesser intensity of pain. A telephone counseling given by specialized nurses can help to reduce the hospitalization rates, as well as help the patient to comply to the therapeutic plan, and increases the perceived psychophysical well being. During the three months of study, the headache symptoms statistically reduced only during the last 5 weeks of follow up. Further studies with a longer follow up are needed to better assess the long term outcomes of this approach (symptoms management and social and healthcare costs).