Liu Ruozhuo, Yu Shengyuan, He Mianwang, Zhao Gang, Yang Xiaosu, Qiao Xiangyang, Feng Jiachun, Fang Yannan, Cao Xiutang, Steiner Timothy J
J Headache Pain. 2013 Jun 3;14(1):47. doi: 10.1186/1129-2377-14-47.
In order to know the status quo of health care for primary headache disorders in China, questions about headache consultation and diagnosis were included in a nationwide population-based survey initiated by Lifting The Burden: the Global Campaign against Headache.
Throughout China, 5,041 unrelated respondents aged 18-65 years were randomly sampled from the general population and visited unannounced at their homes. After basic sociodemographic and headache diagnostic questions, respondents with headache answered further questions about health-care utilization in the previous year.
Significantly higher proportions of respondents with migraine (239/452; 52.9%) or headache on ≥15 days per month (23/48; 47.9%) had consulted a physician for headache than of those with tension-type headache (TTH) (218/531; 41.1%; P < 0.05). Multivariate analysis showed associations between disability and probability of consultation in those with migraine (mild vs. minimal: AOR 3.4, 95% CI: 1.6-7.4; moderate vs. minimal: 2.5, 1.2-5.4; severe vs. minimal: 3.9, 1.9-8.1) and between rural habitation and probability of consulting in those with TTH (AOR: 3.5; 95% CI: 1.9-6.3, P < 0.001). Married respondents with TTH were less likely than unmarried to have consulted (AOR: 0.26; 95% CI: 0.07-0.93; P = 0.038). About half of consultations (47.8-56.5%) for each of the headache disorders were at clinic level in the health system. Consultations in level-3 hospitals were relatively few for migraine (5.9%) but more likely for headache on ≥15 days/month (8.7%) and, surprisingly, for TTH (13.3%). Under-diagnosis and misdiagnosis were common in consulters. More than half with migraine (52.7%) or headache on ≥15 days/month (51.2%), and almost two thirds (63.7%) with TTH, reported no previous diagnosis. Consulters with migraine were as likely (13.8%) to have been diagnosed with "nervous headache" as with migraine. "Nervous headache" (9.8%) and "vascular headache" (7.6%) were the most likely diagnoses in those with TTH, of whom only 5.6% had previously been correctly diagnosed. These were also the most likely diagnoses (14.0% each) in consulters with headache on ≥15 days/month.
This picture of the status quo shows limited reach of headache services in China, and high rates of under-diagnosis and misdiagnosis in those who achieve access to them. This is not a picture of an efficient or cost-effective response to major causes of public ill-health and disability.
为了解中国原发性头痛疾病的医疗现状，“减轻负担：全球抗击头痛运动”发起的一项全国性基于人群的调查纳入了有关头痛咨询和诊断的问题。
在中国各地，从普通人群中随机抽取5041名年龄在18至65岁之间的无亲属关系的受访者，并在其家中进行不事先通知的走访。在询问基本的社会人口统计学和头痛诊断问题后，有头痛症状的受访者回答了有关上一年医疗服务利用情况的进一步问题。
偏头痛患者（239/452；52.9%）或每月头痛≥15天的患者（23/48；47.9%）因头痛咨询医生的比例显著高于紧张型头痛（TTH）患者（218/531；41.1%；P<0.05）。多变量分析显示，偏头痛患者的残疾程度与咨询概率之间存在关联（轻度与最小程度：比值比[AOR]3.4，95%置信区间[CI]：1.6 - 7.4；中度与最小程度：2.5，1.2 - 5.4；重度与最小程度：3.9，1.9 - 8.1），而农村居住情况与TTH患者的咨询概率之间存在关联（AOR：3.5；95%CI：1.9 - 6.3，P<0.001）。已婚的TTH患者咨询的可能性低于未婚患者（AOR：0.26；95%CI：0.07 - 0.93；P = 0.038）。每种头痛疾病的咨询中约一半（47.8 - 56.5%）是在卫生系统的诊所层面进行的。三级医院的咨询对于偏头痛相对较少（5.9%），但对于每月头痛≥15天的情况（8.7%）以及令人惊讶的是对于TTH（13.3%）则更为常见。在咨询者中，漏诊和误诊很常见。超过一半的偏头痛患者（52.7%）或每月头痛≥15天的患者（51.2%），以及几乎三分之二（63.7%）的TTH患者报告此前未被诊断过。偏头痛咨询者被诊断为“神经性头痛”的可能性（13.8%）与被诊断为偏头痛的可能性相同。“神经性头痛”（9.8%）和“血管性头痛”（7.6%）是TTH患者最可能的诊断，其中只有5.6%此前被正确诊断。这些也是每月头痛≥15天的咨询者中最可能的诊断（各为14.0%）。
这种现状表明中国头痛服务的覆盖范围有限，且在能够获得服务的人群中漏诊和误诊率很高。这并非是对公众健康不良和残疾的主要原因的有效或具有成本效益的应对情况。
