Bekkelund Svein I, Ofte Hilde K, Alstadhaug Karl B
Department of Neurology, University Hospital of North Norway , Tromsø
Scand J Prim Health Care. 2014 Sep;32(3):111-6. doi: 10.3109/02813432.2014.944410. Epub 2014 Aug 13.
Cluster headache (CH) may cause excruciating pain and not all patients get satisfactory help. Patient dissatisfaction with general practitioners (GPs) and neurologists, and use of complementary and alternative treatment (CAM) may reflect this. The authors studied patient satisfaction with doctors' treatment and use of CAM in a Norwegian CH cohort.
A total of 196 subjects with a cluster headache diagnosis were identified in the registers of two neurological departments in North Norway.
Of these, 70 with a confirmed diagnosis according to the second edition of the International Classification of Headache Disorders (ICHD-2) completed a comprehensive questionnaire with questions concerning satisfaction with doctors' treatment, use of CAM, and effect of both treatment regimes.
Satisfaction with doctors' treatment was reported in 44/70 (63%) (GPs) and 50/70 (71%) (neurologists) while 39/70 (56%) were satisfied with both. Too long a time to diagnosis, median four years, was the most commonly reported claim regarding doctors' treatment. Use of CAM was reported in 27/70 (39%), and 14/70 (20%) reported experience with ≥ 2 CAM. Ten patients reported benefit from CAM (37% of "CAM users"). The average cluster period was longer in CAM-users than others (p = 0.02), but CAM use was not associated with age, education, use of medication, effect of conventional treatment, duration of cluster attacks, or time to diagnosis.
About two-thirds of CH patients were satisfied with treatment from either GPs or neurologists, and about one-third had used CAM. Despite experiencing diagnostic delay and severe pain, cluster patients seem in general to be satisfied with doctors' conventional treatment.
丛集性头痛(CH)可导致剧痛,并非所有患者都能获得满意的治疗效果。患者对全科医生(GP)和神经科医生的不满以及对补充和替代疗法(CAM)的使用可能反映了这一点。作者研究了挪威丛集性头痛队列中患者对医生治疗的满意度以及CAM的使用情况。
在挪威北部两个神经科的登记册中,共识别出196例丛集性头痛诊断患者。
其中,70例根据《国际头痛疾病分类》第二版(ICHD-2)确诊的患者完成了一份综合问卷,问卷内容涉及对医生治疗的满意度、CAM的使用情况以及两种治疗方式的效果。
44/70(63%)的患者对全科医生的治疗表示满意,50/70(71%)的患者对神经科医生的治疗表示满意,39/70(56%)的患者对两者都满意。关于医生治疗,最常提到的抱怨是诊断时间过长,中位数为四年。27/70(39%)的患者报告使用了CAM,14/70(20%)的患者报告使用过≥2种CAM。10例患者报告从CAM中获益(占“CAM使用者”的37%)。CAM使用者的平均丛集期比其他人更长(p = 0.02),但CAM的使用与年龄、教育程度、药物使用、传统治疗效果、丛集性发作持续时间或诊断时间无关。
约三分之二的丛集性头痛患者对全科医生或神经科医生的治疗感到满意,约三分之一的患者使用过CAM。尽管经历了诊断延迟和剧痛,但丛集性头痛患者总体上似乎对医生的传统治疗感到满意。